Sexually

Transmitted

Disease

Surveillance

2005

Division of STD Prevention

November 2006

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for HIV, STD, and TB Prevention

Division of STD Prevention

Atlanta, Georgia 30333

Centers for Disease Control and

Prevention........................................Julie Louise Gerberding, M.D., M.P.H.

Director

Coordinating Center for

Infectious Diseases ...............................................Mitchell L. Cohen, M.D.

Director

National Center for

HIV, STD, and TB Prevention ..........................Kevin Fenton, M.D., Ph.D.

Director

Division of STD Prevention ............................John M. Douglas, Jr., M.D.

Director

Epidemiology and Surveillance

Branch ...............................................Stuart M. Berman, M.D., Sc.M.

Chief

Surveillance and Special Studies

Team ......................................Hillard S. Weinstock, M.D., M.P.H.

Lead

Statistics and Data Management

Branch ....................................Samuel L. Groseclose, D.V.M., M.P.H.

Chief

Melinda L. Flock, M.S.P.H.

Deputy Chief

Rose Horsley

Team Lead

iii
Copyright Information

All material contained in this report is in the public domain and may be used and reprinted

without special permission; citation to source, however, is appreciated.

Suggested Citation

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance,

2005. Atlanta, GA: U.S. Department of Health and Human Services, November 2006.

Copies can be obtained from the National Center for HIV, STD, and TB Prevention, Centers

for Disease Control and Prevention, 1600 Clifton Road, Mailstop E–07, Atlanta, Georgia

30333. Printed copies and the on-line version of this report can be obtained at the following

web site: http://www.cdc.gov/std/

Selected STD Surveillance and Prevention References and Websites

Supplemental STD Surveillance Reports – 2005

• 2005 Chlamydia Prevalence Monitoring Project: http://www.cdc.gov/std/chlamydia2005/

• 2005 Gonococcal Isolate Surveillance Project: http://www.cdc.gov/std/GISP2005/

• 2005 Syphilis Surveillance Project: http://www.cdc.gov/std/Syphilis2005/

STD Surveillance Reports 1993 – 2005

• http://www.cdc.gov/nchstp/dstd/Stats_Trends/Stats_and_Trends.htm

STD Data on Wonder

• http://wonder.cdc.gov/sexu00.html

STD Fact Sheets

• http://www.cdc.gov/std/healthcomm/fact_sheets.htm

STD Treatment Guidelines

• http://www.cdc.gov/STD/treatment/

STD Program Operation Guidelines

• http://www.cdc.gov/std/program/default.htm

Recommendations for Public Health Surveillance of Syphilis in the United States

• http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a7.htm

Behavioral Surveillance

• YouthRiskBehaviorSurveillanceSystem:http://www.cdc.gov/HealthyYouth/yrbs/index.htm

• National Survey of Family Growth: Advance Data 362. Sexual Behavior and Selected Health

Measures: Men and Women 15-44 Years of Age, United States, 2002. 56 pp. (PHS)

2003-1250: http://www.cdc.gov/nchs/products/pubs/pubd/ad/361-370/ad362.htm

iv
Foreword

“STDs are hidden epidemics of enormous

health and economic consequence in the

United States. They are hidden because

many Americans are reluctant to address

sexual health issues in an open way and

because of the biologic and social

characteristics of these diseases. All

Americans have an interest in STD

prevention because all communities are

impacted by STDs and all individuals

directly or indirectly pay for the costs of

these diseases. STDs are public health

problems that lack easy solutions because

they are rooted in human behavior and

fundamental societal problems. Indeed,

there are many obstacles to effective

prevention efforts. The first hurdle will be to

confront the reluctance of American society

to openly confront issues surrounding

sexuality and STDs. Despite the barriers,

there are existing individual- and

community-based interventions that are

effective and can be implemented

immediately. That is why a multifaceted

approach is necessary to both the

individual and community levels.

To successfully prevent STDs, many

stakeholders need to redefine their

mission, refocus their efforts, modify

how they deliver services, and accept

new responsibilities. In this process,

strong leadership, innovative thinking,

partnerships, and adequate resources

will be required. The additional

investment required to effectively

prevent STDs may be considerable, but

it is negligible when compared with the

likely return on the investment. The

process of preventing STDs must be a

collaborative one. No one agency,

organization, or sector can effectively do

it alone; all members of the community

must do their part. A successful national

initiative to confront and prevent STDs

requires widespread public awareness

and participation and bold national

leadership from the highest levels.”1

v

1Concluding statement from the Institute of

Medicine’s Summary Report, The Hidden

Epidemic: Confronting Sexually Transmitted

Diseases, National Academy Press,

Washington, DC, 1997, p.43.
Preface

Sexually Transmitted Disease Surveillance,

2005 presents statistics and trends for

sexually transmitted diseases (STDs) in the

United States through 2005. This annual

publication is intended as a reference

document for policy makers, program

managers, health planners, researchers,

and others who are concerned with the

public health implications of these diseases.

The figures and tables in this edition

supersede those in earlier

publications of these data.

The surveillance information in this report

is based on the following sources of data:

(1) case reports from state and local STD

programs; (2) the Regional Infertility

Prevention Projects, the National Job

Training Program (formerly the Job Corps),

the Corrections STD Prevalence Monitoring

Project, and the Men Who Have Sex With

Men (MSM) Prevalence Monitoring Project;

(3) the Gonococcal Isolate Surveillance

Project (GISP); and (4) national surveys

implemented by federal and private

organizations.

The STD surveillance systems operated by

state and local STD control programs,

which provide the case report data for

chlamydia, gonorrhea, syphilis, and

chancroid are the data sources of many of

the figures and most of the statistical tables

in this publication. These systems are an

integral part of program management at all

levels of STD prevention and control in the

United States. Because of incomplete

diagnosis and reporting, the number of

STD cases reported to CDC is less than the

actual number of cases occurring in the

United States population. Case report data

for other STDs are not available because

they are not nationally notifiable diseases.

Sexually Transmitted Disease Surveillance,

2005 consists of four parts. The National

Profile contains figures that provide an

overview of STD morbidity in the United

States. The accompanying text identifies

major findings and trends for selected

STDs. The Special Focus Profiles

contain figures and text describing STDs in

selected subgroups and populations that

are a focus of national and state

prevention efforts. The Detailed Tables

provide statistical information about STDs

at the county, metropolitan statistical area

(MSA), regional, state, and national levels.

The Appendix includes information on

interpreting the STD surveillance data

used to produce this report, Healthy

People 2010 STD objectives, Government

Performance and Results Act (GPRA)

goals, and STD surveillance case

definitions.

Selected figures and tables in this document

identify goals that reflect progress towards

some of the Healthy People 2010

(HP2010) national health status objectives

for STDs.1 Appendix Table A3 displays

progress made towards the HP2010 targets

for STDs. These targets are used as

reference points throughout this edition of

Sexually Transmitted Disease Surveillance

2005.

vi
Any comments and suggestions that

would improve the usefulness of future

publications are appreciated and should

be sent to Director, Division of STD

Prevention, National Center for HIV,

STD, and TB Prevention, Centers for

Disease Control and Prevention, 1600

Clifton Road, Mailstop E-02, Atlanta,

Georgia, 30333.

vii

1 U.S. Department of Health and Human Services.

Healthy People 2010. 2nd ed. With Understanding

and Improving Health and Objectives for Improving

Health. 2 vols. Washington, DC: U.S. Government

Printing Office, November 2000.
Acknowledgments

Publication of this report would not have been possible without the contributions of the

State and Territorial Health Departments and the Sexually Transmitted Disease Control

Programs and the Regional Infertility Prevention Projects, which provided surveillance

data to the Centers for Disease Control and Prevention.

This report was prepared by the following staff and contractors of the Division of STD

Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and

Prevention:

Office of the Director

John Douglas

Amy Pulver

Epidemiology and Surveillance Branch

John Beltrami

Stuart Berman

Deblina Datta

Donna Helms

Riduan Joesoef

Katrina Kramer

Lori Newman

Catherine Lindsey Satterwhite

Cristen Suhr

Hillard Weinstock

Eileen Yee

Statistics and Data Management Branch

Susan Bradley

Jim Braxton

Sharon Clanton

Darlene Davis

Melinda Flock

LaZetta Grier

Samuel Groseclose

Alesia Harvey

Rose Horsley

Kathleen Hutchins

Rob Nelson

Maya Sternberg

Akbar Zaidi

viii
ix

Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Figures in the National Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Figures in the Special Focus Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Tables in the National Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv

Geographic Divisions of the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

National Overview of Sexually Transmitted Diseases, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

National Profile

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Other Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Special Focus Profiles

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

STDs in Women and Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

STDs in Adolescents and Young Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

STDs in Racial and Ethnic Minorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

STDs in Men Who Have Sex with Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

STDs in Persons Entering Corrections Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Tables

National Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Chancroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Selected STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Appendix

Interpreting STD Surveillance Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values

for selected demographic variables by state, 2005 . . . . . . . . . . . . . . . . . . . . . 147

Table A2. Reported cases of sexually transmitted disease by sex and reporting source:

United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status . . . . . . . . .

Table A4. Government Performance Results Act (GPRA) Sexually Transmitted

Diseases Goals and Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

STD Surveillance Case Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Figures in the National Profile

Chlamydia

Figure 1. Chlamydia — Rates: Total and by sex: United States, 1986–2005. . . . . . . . . . 10

Figure 2. Chlamydia — Rates by region: United States, 1996–2005 . . . . . . . . . . . . . . . . 10

Figure 3. Chlamydia — Rates by state: United States and outlying areas, 2005 . . . . . . . 11

Figure 4. Chlamydia — Rates by county: United States, 2005 . . . . . . . . . . . . . . . . . . . . 11

Figure 5. Chlamydia — Cases by reporting source and sex: United States,

1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Figure 6. Chlamydia — Rates by race/ethnicity: United States, 1996–2005 . . . . . . . . . . 12

Figure 7. Chlamydia — Age- and sex-specific rates: United States, 2005 . . . . . . . . . . . . 13

Figure 8. Chlamydia — Median state-specific positivity among 15- to 24-year-old

women tested in family planning clinics: United States, 1997–2005 . . . . . . . . . 13

Figure 9. Chlamydia — Positivity among 15- to 24-year-old women tested in

family planning clinics by state: United States and outlying areas, 2005. . . . . . 14

Figure 10. Chlamydia — Trends in positivity among 15- to 24-year-old women

tested in family planning clinics by HHS region, 2001–2005 . . . . . . . . . . . . . . 14

Gonorrhea

Figure 11. Gonorrhea — Rates: United States, 1941–2005 and the Healthy

People 2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Figure 12. Gonorrhea — Rates: Total and by sex: United States, 1986–2005

and the Healthy People 2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Figure 13. Gonorrhea — Rates by region: United States 1996–2005 and the

Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Figure 14. Gonorrhea — Rates by state: United States and outlying areas, 2005 . . . . . . . 22

Figure 15. Gonorrhea — Rates by county: United States, 2005 . . . . . . . . . . . . . . . . . . . . 23

Figure 16. Gonorrhea — Cases by reporting source and sex: United States,

1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Figure 17. Gonorrhea — Rates by race/ethnicity: United States, 1996–2005 . . . . . . . . . . 24

Figure 18. Gonorrhea — Age- and sex-specific rates: United States, 2005 . . . . . . . . . . . . 24

Figure 19. Gonorrhea — Age-specific rates among women 15 to 44 years of age:

United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Figure 20. Gonorrhea — Age-specific rates among men 15 to 44 years of age:

United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Figure 21. Gonorrhea — Positivity among 15- to 24-year-old women tested in family

planning clinics by state: United States and outlying areas, 2005 . . . . . . . . . . . 26

Figure 22. Gonococcal Isolate Surveillance Project (GISP) — Location of participating

clinics and regional laboratories: United States, 2005. . . . . . . . . . . . . . . . . . . . 26

Figure 23. Gonococcal Isolate Surveillance Project (GISP) — Penicillin and tetracycline

resistance among GISP isolates, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Figure 24. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance or intermediate resistance to

ciprofloxacin, 1990–2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Figure 25. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

x
Syphilis

Figure 26. Syphilis — Reported cases by stage of infection: United States, 1941–2005. . . 33

Figure 27. Primary and secondary syphilis — Rates: Total and by sex: United States,

1986–2005 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 33

Figure 28. Primary and secondary syphilis — Rates by region: United States,

1996–2005 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 34

Figure 29. Primary and secondary syphilis — Rates by state: United States and

outlying areas, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Figure 30. Primary and secondary syphilis — Rates by county: United States, 2005. . . . . 35

Figure 31. Primary and secondary syphilis — Cases by reporting source and sex:

United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Figure 32. Primary and secondary syphilis — Rates by race/ethnicity: United States,

1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Figure 33. Primary and secondary syphilis — Male-to-female rate ratios: United States,

1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Figure 34. Primary and secondary syphilis — Age- and sex-specific rates:

United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Figure 35. Primary and secondary syphilis — Age-specific rates among women 15 to

44 years of age: United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Figure 36. Primary and secondary syphilis — Age-specific rates among men

15 to 44 years of age: United States, 1996–2005. . . . . . . . . . . . . . . . . . . . . . . 38

Figure 37. Congenital syphilis (CS) — Reported cases for infants < 1 year of age

and rates of primary and secondary syphilis among women: United States,

1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Figure 38. Congenital syphilis — Rates for infants < 1 year of age: United States,

1996–2005 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 39

Other Sexually Transmitted Diseases

Figure 39. Chancroid — Reported cases: United States, 1981–2005. . . . . . . . . . . . . . . . . 43

Figure 40. Genital herpes — Initial visits to physicians’ offices: United States,

1966–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Figure 41. Genital warts — Initial visits to physicians’ offices: United States,

1966–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Figure 42. Trichomoniasis and other vaginal infections in women — Initial visits to

physicians’ offices: United States, 1966–2005 . . . . . . . . . . . . . . . . . . . . . . . . . 44

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia — Rates among women by state: United States and

outlying areas, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Figure B. Gonorrhea — Rates among women by state: United States and

outlying areas, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Figure C. Primary and secondary syphilis — Rates among women by state:

United States and outlying areas, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

xi
Figure D. Congenital syphilis — Rates for infants < 1 year of age by state:

United States and outlying areas, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Figure E. Chlamydia — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2005 . . . . . . . . . . . . . . . . . . 53

Figure F. Gonorrhea — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2005 . . . . . . . . . . . . . . . . . . 53

Figure G. Ectopic pregnancy — Hospitalizations of women 15 to 44 years of age:

United States, 1996–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Figure H. Pelvic inflammatory disease — Hospitalizations of women 15 to 44 years

of age: United States, 1996–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Figure I. Pelvic inflammatory disease — Initial visits to physicians’ offices by women

15 to 44 years of age: United States, 1996–2005. . . . . . . . . . . . . . . . . . . . . . . 55

STDs in Adolescents and Young Adults

Figure J. Chlamydia — Trends in positivity among 15- to 19-year-old women

tested in family planning clinics by HHS region, 2001–2005 . . . . . . . . . . . . . . 60

Figure K. Chlamydia — Prevalence among 16- to 24-year-old women entering

the National Job Training Program by state of residence: United States

and outlying areas, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Figure L. Chlamydia — Prevalence among 16- to 24-year-old men entering the

National Job Training Program by state of residence: United States and

outlying areas, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Figure M. Gonorrhea — Prevalence among 16- to 24-year-old women entering

the National Job Training Program by state of residence: United States

and outlying areas, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Figure N. Gonorrhea — Prevalence among 16- to 24-year-old men entering

the National Job Training Program by state of residence: United States

and outlying areas, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

STDs in Racial and Ethnic Minorities

Figure O. Chlamydia — Rates by race/ethnicity and sex: United States, 2005 . . . . . . . . . 66

Figure P. Gonorrhea — Rates by race/ethnicity and sex: Unites States, 2005 . . . . . . . . . 66

Figure Q. Gonorrhea — Rates among 15- to 19-year-old females by race/ethnicity:

United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Figure R. Gonorrhea — Rates among 15- to 19-year-old males by race/ethnicity:

United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Figure S. Primary and secondary syphilis — Rates by race/ethnicity and sex:

United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Figure T. Primary and secondary syphilis — Rates among 15- to 19-year-old

females by race/ethnicity: United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . 68

Figure U. Primary and secondary syphilis — Rates among 15- to 19-year-old

males by race/ethnicity: United States, 1996–2005. . . . . . . . . . . . . . . . . . . . . . 69

Figure V. Congenital syphilis — Rates among infants < 1 year of age by mother’s

race/ethnicity: United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

STDs in Men Who Have Sex with Men

Figure W. MSM Prevalence Monitoring Project — Number of gonorrhea tests and

number of positive tests in men who have sex with men, STD clinics,

1999–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

xii
Figure X. MSM Prevalence Monitoring Project — Syphilis serologic reactivity

among men who have sex with men, STD clinics, 1999–2005. . . . . . . . . . . . . 76

Figure Y. MSM Prevalence Monitoring Project — Test positivity for gonorrhea,

chlamydia, and HIV and seroreactivity to syphilis among men who have

sex with men, by race/ethnicity, STD clinics, 2005 . . . . . . . . . . . . . . . . . . . . . . . 76

Figure Z. MSM Prevalence Monitoring Project — Test positivity for gonorrhea and

chlamydia and syphilis seroreactivity among men who have sex with

men, by HIV status, STD clinics, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Figure AA. Gonococcal Isolate Surveillance Project (GISP) — Percent of urethral

Neisseria gonorrhoeae isolates obtained from men who have sex with

men attending STD clinics, 1988–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Figure BB. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates obtained from men who have sex with men

attending STD clinics, 2002–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

STDs in Persons Entering Corrections Facilities

Figure CC. Chlamydia — Positivity by age, juvenile corrections facilities, 2005 . . . . . . . . . 82

Figure DD. Chlamydia — Positivity by age, adult corrections facilities, 2005 . . . . . . . . . . . 82

Figure EE. Gonorrhea — Positivity by age, juvenile corrections facilities, 2005 . . . . . . . . . 83

Figure FF. Gonorrhea — Positivity by age, adult corrections facilities, 2005 . . . . . . . . . . . 83

Table AA. Chlamydia — Positivity among men and women in juvenile corrections

facilities, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Table BB. Chlamydia — Positivity among men and women in adult corrections

facilities, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Table CC. Gonorrhea — Positivity among men and women in juvenile corrections

facilities, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Table DD. Gonorrhea — Positivity among men and women in adult corrections

facilities, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Table EE. Syphilis— Positivity among men and women in juvenile corrections

facilities, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Table FF. Syphilis— Positivity among men and women in adult corrections

facilities, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

xiii
Tables in the National Profile

National Summary

Table 1. Cases of sexually transmitted diseases reported by state health departments

and rates per 100,000 population: United States, 1941–2005 . . . . . . . . . . . . 89

Chlamydia

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates:

United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Table 3. Chlamydia — Reported cases and rates by state/area and region listed in

alphabetical order: United States and outlying areas, 2001–2005 . . . . . . . . . . 92

Table 4. Chlamydia — Women – Reported cases and rates by state/area and

region listed in alphabetical order: United States and outlying areas,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Table 5. Chlamydia — Men – Reported cases and rates by state/area and region

listed in alphabetical order: United States and outlying areas, 2001–2005 . . . . 94

Table 6. Chlamydia — Reported cases and rates in selected metropolitan statistical

areas (MSAs) listed in alphabetical order: United States, 2001–2005 . . . . . . . . 95

Table 7. Chlamydia — Women – Reported cases and rates in selected

metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Table 8. Chlamydia — Men – Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order:

United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Table 9. Chlamydia — Reported cases and rates per 100,000 population by

age group and sex: United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . 98

Table 10A. Chlamydia — Reported cases by race/ethnicity, age group and sex:

United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Table 10B. Chlamydia — Rates per 100,000 population by race/ethnicity, age

group and sex: United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Gonorrhea

Table 11. Gonorrhea — Reported cases and rates by state/area, ranked by rates:

United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Table 12. Gonorrhea — Reported cases and rates by state/area and region listed

in alphabetical order: United States and outlying areas, 2001–2005 . . . . . . . 103

Table 13. Gonorrhea — Women – Reported cases and rates by state/area

and region listed in alphabetical order: United States and outlying

areas, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Table 14. Gonorrhea — Men – Reported cases and rates by state/area and

region listed in alphabetical order: United States and outlying

areas, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Table 15. Gonorrhea — Counties and independent cities ranked by number

of reported cases: United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Table 16. Gonorrhea — Reported cases and rates in selected metropolitan statistical

areas (MSAs) listed in alphabetical order: United States, 2001–2005 . . . . . . . 107

Table 17. Gonorrhea — Women – Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

xiv
Table 18. Gonorrhea — Men – Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Table 19. Gonorrhea — Reported cases and rates per 100,000 population by

age group and sex: United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . 110

Table 20A. Gonorrhea — Reported cases by race/ethnicity, age group and sex:

United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Table 20B. Gonorrhea — Rates per 100,000 population by race/ethnicity, age

group and sex: United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Syphilis

Table 21. All stages of syphilis — Reported cases and rates by state/area

and region listed in alphabetical order: United States and outlying areas,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Table 22. All stages of syphilis — Reported cases and rates in selected metropolitan

statistical areas† (MSAs) listed in alphabetical order: United States,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Table 23. Primary and secondary syphilis — Reported cases and rates by state/area,

ranked by rates: United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Table 24. Primary and secondary syphilis — Reported cases and rates by state/area

and region listed in alphabetical order: United States and outlying areas,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Table 25. Primary and secondary syphilis — Women – Reported cases and rates

by state/area and region listed in alphabetical order: United States

and outlying areas, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Table 26. Primary and secondary syphilis — Men – Reported cases and rates

by state/area and region listed in alphabetical order: United States and

outlying areas, 2001–2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Table 27. Primary and secondary syphilis — Counties and independent cities* ranked

by number of reported cases: United States, 2005 . . . . . . . . . . . . . . . . . . . . . 120

Table 28. Primary and secondary syphilis — Reported cases and rates in selected

metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Table 29. Primary and secondary syphilis — Women – Reported cases and rates

in selected metropolitan statistical areas (MSAs) listed in alphabetical

order: United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Table 30. Primary and secondary syphilis — Men – Reported cases and rates

in selected metropolitan statistical areas (MSAs) listed in alphabetical

order: United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Table 31. Primary and secondary syphilis — Reported cases and rates per 100,000

population by age group and sex: United States, 2001–2005. . . . . . . . . . . . . 124

Table 32A. Primary and secondary syphilis — Reported cases by race/ethnicity,

age group and sex: United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . 126

Table 32B. Primary and secondary syphilis — Rates per 100,000 population by

race/ethnicity, age group and sex: United States, 2001–2005. . . . . . . . . . . . . 127

Table 33. Early latent syphilis — Reported cases and rates by state/area and

region listed in alphabetical order: United States and outlying

areas, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Table 34. Early latent syphilis — Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

xv
Table 35. Late and late latent syphilis — Reported cases and rates by state/area

and region listed in alphabetical order: United States and outlying areas,

2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Table 36. Late and late latent syphilis — Reported cases and rates in selected

metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2001–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Table 37. Congenital syphilis — Reported cases and rates in infants 1 year of age:

United States (excluding outlying areas), 1963–2005. . . . . . . . . . . . . . . . . . . 132

Table 38. Congenital syphilis — Reported cases and rates in infants 1 year of age

by state, ranked by rates: United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . 133

Table 39. Congenital syphilis — Reported cases and rates in infants 1 year of age

by state/area and region listed in alphabetical order: United States and

outlying areas, 2001–2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Table 40. Congenital syphilis — Reported cases and rates in infants 1 year of age

by race/ethnicity of mother: United States, 2001–2005 . . . . . . . . . . . . . . . . . 135

Chancroid

Table 41. Chancroid — Reported cases and rates by state/area listed in alphabetical

order: United States and outlying areas, 2001–2005 . . . . . . . . . . . . . . . . . . . 136

Selected STDs

Table 42. Selected STDs and complications — Initial visits to physicians' offices:

United States, 1966–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Interpreting STD Surveillance Data

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values

for selected demographic variables by state and by nationally notifiable

STD, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Table A2. Reported cases of sexually transmitted disease reporting source and

by sex: United States, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status . . . . . . 149

Table A4. Government Performance Results Act (GPRA) Sexually Transmitted

Diseases Goals and Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

xvi
xvii

West Midwest Northeast

South

Geographic Divisions of the United States

West Midwest South Northeast

Alaska Illinois Alabama Connecticut

Arizona Indiana Arkansas Maine

California Iowa Delaware Massachusetts

Colorado Kansas District of Columbia New Hampshire

Hawaii Michigan Florida New Jersey

Idaho Minnesota Georgia New York

Montana Missouri Kentucky Pennsylvania

Nevada Nebraska Louisiana Rhode Island

New Mexico North Dakota Maryland Vermont

Oregon Ohio Mississippi

Utah South Dakota North Carolina

Washington Wisconsin Oklahoma

Wyoming South Carolina

Tennessee

Texas

Virginia

West Virginia

National Overview of Sexually

Transmitted Diseases, 2005

The logo on the cover of Sexually

Transmitted Disease Surveillance, 2005 is a

reminder of the multifaceted, national

dimensions of the morbidity, mortality, and

costs that result from sexually transmitted

diseases (STDs) in the United States. It

highlights the central role of STD

prevention in improving health among

women and infants and in promoting HIV

prevention. Organized collaboration among

interested, committed public and private

organizations is the key to reducing STDs

and their related health burdens. As noted

in the report of the Institute of Medicine,

The Hidden Epidemic: Confronting

Sexually Transmitted Diseases,1 surveillance

is a key component of our efforts to prevent

and control these diseases.

This overview summarizes national

surveillance data on the three diseases for

which there are federally-funded control

programs: chlamydia, gonorrhea, and

syphilis. Several observations for 2005 are

worthy of note.

Chlamydia

In 2005, 976,445 cases of genital

Chlamydia trachomatis infection were

reported to CDC (Table 1). This case count

corresponds to a rate of 332.5 cases per

100,000 population, an increase of 5.1%

compared with the rate in 2004. Rates of

reported chlamydia infections among

women have been increasing annually

since the late 1980s when public programs

for screening and treatment of women were

first established to avert pelvic

inflammatory disease and related

complications. The continued increase in

chlamydia case reports in 2005 most likely

represents a continued increase in screening

for this infection, but it may also reflect a

true increase in morbidity.

In 2005, the overall rate of chlamydia

infection in the United States among

women (496.5 cases per 100,000 females)

was over three times the rate among men

(161.1 cases per 100,000 males), reflecting

the large number of women screened for

this disease (Tables 4 and 5). However, with

the increased availability of urine testing,

men are increasingly being tested for

chlamydia infection. From 2001 through

2005, the chlamydia rate in men increased

by 43.5% (compared with a 15.6%

increase in women over this period).

Data from multiple sources on prevalence

of chlamydia infection in defined

populations have been useful in monitoring

disease burden and guiding chlamydia

screening programs.

In 2005, the median state-specific

chlamydia test positivity among women 15

to 24 years old who were screened at

selected family planning clinics in all states,

the District of Columbia, Puerto Rico, and

the Virgin Islands was 6.3% (range 3.0% to

20.3%) (Figure 8).

At selected prenatal clinics in 25 states,

Puerto Rico, and the Virgin Islands the

median state-specific chlamydia prevalence

was 8.0% (range 2.8% to 16.9%) (Figure E).

The prevalence of infection is greater

among economically-disadvantaged

STD Surveillance 2005 Overview 1
women 16 to 24 years of age who entered

the National Job Training Program in 2005

from 39 states, the District of Columbia,

and Puerto Rico. The median state-specific

prevalence was 9.2% (range 3.1% to

14.5%) (Figure K). Among men entering the

program in 2005 from 48 states, the District

of Columbia, and Puerto Rico the median

state-specific chlamydia prevalence was

8.1% (range 0.0% to 14.8%) (Figure L).

The prevalence is even greater among

adolescent women entering 57 juvenile

detention centers; the median chlamydia

positivity by facility was 14.2% (range 3.7%

to 33.7%) (Table AA).

Among adolescent men entering 87

juvenile detention centers, the median

chlamydia positivity was 6.0% by facility

(range 0.0% to 44.8%) (Table AA).

Although these data on prevalence are

not entirely comparable because of

differences in the populations screened,

in the performance characteristics of the

screening tests, and variations in screening

criteria, they provide important information

on the continuing high burden of disease in

the United States.

Gonorrhea

Following a 74% decline in the rate of

reported gonorrhea from 1975 to 1997,

overall gonorrhea rates appeared to

plateau. In 2005, 339,593 cases of

gonorrhea were reported in the United

States, corresponding to a rate of 115.6 per

100,000 population, a slight increase from

2004 (Figure 11 and Table 1). This rate

considerably exceeds the Healthy People

2010 (HP2010) target of 19 cases per

100,000 population.

As in previous years, in 2005 the South had

the highest gonorrhea rate among the four

regions of the country (Table 12). However,

the rate in the South has declined by

17.6% since 2001, and declines have also

been observed in the Northeast. Minimal

change has been seen in the Midwest. In

contrast, the rate in the West has increased

by 35.4% from 60.2 cases per 100,000

population in 2001 to 81.5 cases in 2005.

For the fourth straight year, the gonorrhea

rate in women in 2005 was slightly higher

(119.1 per 100,000 population) than the

rate among men (111.5 per 100,000

population) (Figure 12). As with chlamydia,

rates of gonorrhea in women are

particularly high in 15- to 19-year-olds, and

in men, are highest in 20- to 24-year-olds

(Figure 18). Although the gonorrhea rate

among 15- to 19-year-olds has decreased

in recent years, from 2004 to 2005 this rate

increased 3.9% (Table 19). Similar to

previous years, in 2005, African-American

15- to 19-year-old females had the highest

gonorrhea rate of any age and race/ethnic

group (2,814.0 cases per 100,000

population) (Table 20B). However,

gonorrhea rates among both AfricanAmerican men and women decreased from

2001 through 2005 (19.4% and 16.1%,

respectively). In contrast, gonorrhea rates

among both white men and women have

increased between 2001 and 2005 (18.9%

and 20.4%, respectively).

In 2005, data on gonorrhea prevalence in

defined populations were available from

several sources. These data showed a

continuing high burden of disease in

adolescents and young adults in some parts

of the United States.

For 16- to 24-year-old women entering the

National Job Training Program in 32 states

and the District of Columbia in 2005, the

median state-specific gonorrhea prevalence

was 2.4% (range 0.0% to 6.6%).

Among men entering the program from 14

states, the median state-specific gonorrhea

prevalence was 2.2% (range 0.0% to 6.1%).

Among women entering juvenile

corrections facilities the median gonorrhea

positivity was 4.7% (range 0.9% to 14.2%);

the median gonorrhea positivity for men

2 Overview STD Surveillance 2005
entering juvenile corrections facilities was

1.0% (range 0.0% to 19.0%).

Among women entering adult corrections

facilities, the median gonorrhea positivity

was 2.8% (range 0% to 13.8%). In men,

the median gonorrhea positivity was 2.3%

(range 0.0 to 11.8%) in adult corrections

facilities.

Among men who have sex with men

attending eight STD clinics, the median

clinic urethral positivity was 11% (range 8%

to 14%).

There remains considerable geographic

variation in the prevalence of

fluoroquinolone-resistance within the

United States, at least for heterosexuals,

with rates highest in the Western part of the

country. In the Gonococcal Isolate

Surveillance Project (GISP), a sentinel

surveillance project located in 27 STD

clinics throughout the United States, the

proportion of isolates among men who

have sex with men (MSM) that were

resistant to ciprofloxacin increased again in

2005 to 29%. The overall proportion of

resistant isolates among heterosexuals was

3.8% in 2005, up from 2.9% in 2004.

Fluoroquinolone-resistant isolates were

identified in 25 of the 27 GISP clinics but

prevalence was highest in Western sites.

Syphilis

The rate of primary and secondary (P&S)

syphilis reported in the United States

decreased during the 1990s and in 2000

was the lowest since reporting began in

1941. The low rate of syphilis and the

concentration of the majority of syphilis

cases in a small number of geographic

areas led to the development of the

National Plan to Eliminate Syphilis from the

United States, which was announced by the

Surgeon General in 1999 and revised in

2006.2 The rate of P&S syphilis in the

United States declined by 89.7% from 1990

through 2000. However, the rate of P&S

syphilis has increased each year since 2001,

mostly among men, but also in women for

the past year. In 2005, P&S syphilis cases

reported to CDC increased to 8,724 from

7,980 in 2004, an increase of 9.3%. The

rate in men increased 8.5% while that in

women increased 12.5%. Cases of

congenital syphilis continued to decline;

329 cases of congenital were reported in

2005, down from 371 in 2004.

Although wide disparities exist in the rates

of STDs among racial and ethnic groups,

there has been a reduction in these

differences for syphilis over the past five

years. The P&S syphilis rate for 2005

among African Americans was 5.4 times

the rate among whites, reflecting a

substantial decline from 1999, when the

rate among African Americans was 29

times greater than that among whites (Table

32B). While this has reflected decreasing

rates among African Americans, it also

reflects significant increases among white

men during the past five years. In 2005,

increases were observed among both

African-American men (15.7 cases per

100,000 population, up from 13.9 in 2004)

and African-American women (4.4 cases

per 100,000 population, up from 4.2 in

2004). An increase was also observed

among white men (3.3 cases per 100,000

population), up from 3.1 in 2004, while the

rate in white women remained the same

(0.3 per 100,000 population).

While syphilis elimination efforts have

successfully focused on heterosexual

minority populations at risk for syphilis,

recent increases in syphilis among MSM

and smaller increases among women and

African Americans highlight the importance

of continually reassessing and refining

surveillance, prevention, and control

strategies.

STD Surveillance 2005 Overview 3
4 Overview STD Surveillance 2005

1 Institute of Medicine. The Hidden Epidemic:

Confronting Sexually Transmitted Diseases,

Committee on Prevention and Control of

Sexually Transmitted Diseases, National

Academy Press, Washington, DC, 1997.

2 Division of STD Prevention. The National Plan

to Eliminate Syphilis from the United States.

National Center for HIV, STD, and TB

Prevention, Centers for Disease Control and

Prevention, 2006.
NATIONAL PROFILE
NATIONAL PROFILE
National Profile

The National Profile section contains

figures showing trends and the distribution

of nationally reportable sexually transmitted

diseases (chlamydia, gonorrhea, syphilis and

chancroid) by age, sex, race/ethnicity, and

location for the United States. Where relevant,

the figures illustrate progress towards specific

Healthy People 2010 targets* for the nation.1

STD Surveillance 2005 National Profile National Profile 5

* See the Appendix for a listing of the Healthy

People 2010 objectives for the diseases

addressed in this report.

1 U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

Chlamydia

Background

Chlamydia trachomatis infections are the

most commonly reported notifiable disease

in the United States. They are among the

most prevalent of all STDs and, since 1994,

have comprised the largest proportion of all

STDs reported to CDC (Table 1). In

women, chlamydia infections, which are

usually asymptomatic, may result in pelvic

inflammatory disease (PID), which is a

major cause of infertility, ectopic pregnancy,

and chronic pelvic pain. Data from a

randomized controlled trial of chlamydia

screening in a managed care setting

suggested that screening programs can lead

to a reduction in the incidence of PID by as

much as 60%.1 As with other inflammatory

STDs, chlamydia infection can facilitate the

transmission of HIV infection. In addition,

pregnant women infected with chlamydia

can pass the infection to their infants during

delivery, potentially resulting in neonatal

ophthalmia and pneumonia. Due to the

large burden of disease and risks associated

with infection, CDC recommends screening

all sexually active women aged less than 26

years for chlamydia.2

The increase in reported chlamydia

infections during the last 10 years reflects

the expansion of chlamydia screening

activities, use of increasingly sensitive

diagnostic tests, an increased emphasis on

case reporting from providers and

laboratories, and improvements in the

information systems for reporting.

However, many women who are at risk are

still not being tested, reflecting, in part, lack

of awareness among some health care

providers and limited resources available to

support screening. Chlamydia screening

and reporting are likely to continue to

expand further in response to the Health

Plan Employer Data and Information Set

(HEDIS) measure for chlamydia screening

of sexually active women 15 through 25

years of age who receive medical care

through managed care organizations or

Medicaid.3 To better monitor trends in

disease burden in defined populations

during the expansion of chlamydia

screening activities, data on chlamydia

positivity among persons screened in a

variety of settings are used; in most

instances, test positivity serves as a

reasonable approximation of prevalence.4

Chlamydia – United States

In 2000, for the first time, all 50 states and

the District of Columbia had regulations

requiring the reporting of chlamydia cases.

In 2005, 976,445 chlamydia infections

were reported to CDC from 50 states and

the District of Columbia (Table 1). This case

count corresponds to a rate of 332.5 cases

per 100,000 population, an increase of

5.1% compared with the rate of 316.5 in

2004. The reported number of chlamydia

infections was almost three times the

number of reported cases of gonorrhea

(339,593 gonorrhea cases were reported in

2005) (Table 1).

From 1986 through 2005, the rates of

reported chlamydia infection increased

from 35.2 to 332.5 cases per 100,000

population (Figure 1, Table 1). The

continuing increase in reported cases likely

represents the further expansion of

screening for this infection, the

development and use of more sensitive

STD Surveillance 2005 National Profile Chlamydia 7
screening tests, and more complete national

reporting.

Chlamydia by Sex

In 2005, the overall rate of reported

chlamydia infection among women in the

United States (496.5 cases per 100,000

females) was over three times higher than

the rate among men (161.1 cases per

100,000 males), likely reflecting a greater

number of women screened for this

infection (Figure 1, Tables 4 and 5). The

lower rates among men also suggest that

many of the sex partners of women with

chlamydia are not diagnosed or reported.

However, with the advent of highly

sensitive nucleic acid amplification tests that

can be performed on urine, symptomatic

and asymptomatic men are increasingly

being diagnosed with chlamydia infection.

From 2001 through 2005, the chlamydia

infection rate in men increased by 43.5%

(from 112.3 to 161.1 cases per 100,000

males) compared with a 15.6% increase in

women over the same period (from 429.6

to 496.5 cases per 100,000 females).

Chlamydia by Region

For the years 1996–2001, the chlamydia

rates in the Southern region of the United

States were slightly higher than the rates in

any other region of the country (Figure 2,

Table 3). For the years 2002–2005, overall

rates were comparable in the Midwest,

West, and South (353.7, 343.6, 338.1 cases

per 100,000 population, respectively).

Although slight increases occurred in all

regions, rates have remained lowest in the

Northeast since 1996. In 2005, the case

rate per 100,000 population in the

Northeast was 282.5.

Chlamydia by State

In 2005, chlamydia rates per 100,000

population by state ranged from 141.7

cases in New Hampshire to 732.6 cases in

Mississippi (Figure 3, Table 2). Thirty-two

states and one outlying area had chlamydia

case rates higher than 300.0 cases per

100,000 population.

Chlamydia by County

Counties in the United States with the

highest chlamydia case rates per 100,000

population were located primarily in the

Southeast and West, including Alaska

(Figure 4). In 2005, 799 (25.4%) of 3,140

counties had rates greater than 300.0 cases

per 100,000 population. Rates per 100,000

population were 150.0 or less in 1,391

counties (44.3%) and between 150.1 and

300.0 in 950 counties (30.3%).

Chlamydia by Reporting Source

The majority of chlamydia cases reported

in 2005 were reported through non-STD

clinics (Figure 5, Table A2). Among women,

only 12.5% of chlamydia cases were

reported through an STD clinic (92,229 of

740,371 total cases). Women are more

frequently asymptomatic and less likely

than men to seek care at an STD clinic. In

contrast, among men, 33.8% of chlamydia

cases were reported through an STD clinic

(78,677 of 232,781 total cases).

Chlamydia by Race

In 2005, chlamydia rates increased for all

race/ethnic groups (Figure 6, Table 10B).

The rate of chlamydia among blacks was

over eight times higher than that of whites

(1,247.0 and 152.1 cases per 100,000,

respectively). The rates among American

Indian/Alaska Natives (748.7) and

Hispanics (459.0) were also higher than

that of whites (4.9 and 3.0 times higher,

respectively).

Chlamydia by Age and Sex

Among women, the highest age-specific

rates of reported chlamydia in 2005 were

among 15- to 19-year-olds (2,796.6 cases

per 100,000 females) and 20- to 24-year8 Chlamydia National Profile STD Surveillance 2005
olds (2,691.1 cases per 100,000 females).

These increased rates in women may be, in

part, due to increased screening in this

group. Age-specific rates among men, while

substantially lower than the rates in women,

were highest in the 20- to 24-year-olds

(804.7 cases per 100,000 males) (Figure 7,

Table 9).

Chlamydia Screening and Prevalence

Monitoring Project

Chlamydia screening and prevalence

monitoring activities were initiated in

Health and Human Services (HHS) Region

X (Alaska, Idaho, Oregon, Washington) in

1988 as a CDC-supported demonstration

project. In 1993, chlamydia screening

services for women were expanded to three

additional HHS regions (III, VII, and VIII)

and, in 1995, to the remaining HHS regions

(I, II, IV, V, VI, and IX). In some regions,

federally-funded chlamydia screening

supplements local- and state-funded

screening programs. Screening criteria and

practices vary by region and state.

In 2005, the median state-specific

chlamydia test positivity among 15- to

24-year-old women who were tested during

visits to selected family planning clinics in

all states and outlying areas was 6.3%

(range 3.0% to 20.3%) (Figures 8 and 9).

See Appendix (Chlamydia, Gonorrhea,

and Syphilis Prevalence Monitoring) for

details.

To examine trends in regional chlamdyia

positivity, rates were adjusted to account for

changes in laboratory test methods and

associated increases in test sensitivity

(Figure 10, see Appendix).5 Even after

adjustment, chlamydia test positivity has

remained fairly stable within regions from

2001–2005. Positivity slightly decreased in

six of ten HHS regions from 2004 through

2005, increased in three regions, and

remained the same in one region.

Chlamydia Among Special

Populations

Additional information on chlamydia

screening programs for women of

reproductive age and chlamydia among

adolescents and minority populations can

be found in the Special Focus Profiles.

STD Surveillance 2005 National Profile Chlamydia 9

1 Scholes D, Stergachis A, Heidrich FE, Andrilla

H, Holmes KK, Stamm WE. Prevention of pelvic

inflammatory disease by screening for cervical

chlamydial infection. N Engl J Med

1996;34(21): 1362-66.

2 Centers for Disease Control and Prevention.

Sexually Transmitted Diseases Treatment

Guidelines, 2006. MMWR, 2006;55(No.

RR-11):38.

3 National Committee for Quality Assurance

(NCQA). HEDIS 2000: Technical Specifications,

Washington, DC, 1999, pp. 68-70, 285-286.

4 Dicker LW, Mosure DJ, Levine WC. Chlamydia

positivity versus prevalence: what's the

difference? Sexually Transmitted Diseases

1998;25:251-3.

5 Dicker LW, Mosure DJ, Levine WC, et al.

Impact of switching laboratory tests on reported

trends in Chlamydia trachomatis infections. Am

J Epidemiol 2000;51:430-5.
10 Chlamydia National Profile STD Surveillance 2005

Rate (per 100,000 population)

Men

Women

Total

0

100

200

300

400

500

1986 88 90 92 94 96 98 2000 02 04

Figure 1. Chlamydia — Rates: Total and by sex: United States, 1986–2005

Note: As of January 2000, all 50 states and the District of Columbia had regulations requiring the

reporting of chlamydia cases.

Rate (per 100,000 population)

West

Midwest

Northeast

South

0

80

160

240

320

400

1996 97 98 99 2000 01 02 03 04 05

Figure 2. Chlamydia — Rates by region: United States, 1996–2005
STD Surveillance 2005 National Profile Chlamydia 11

Rate per 100,000

population

Guam 485.9

Puerto Rico 95.4

Virgin Is. 216.0

<=150.0

150.1-300.0

>300.0

(n= 2)

(n= 18)

(n= 33)

VT 154.0

NH 141.7

MA 224.6

RI 302.5

CT 315.1

NJ 220.2

DE 408.5

MD 329.1

377.7

664.4

370.2 309.1

364.2 335.4

249.3

380.1

434.7

200.9

397.7 321.6

250.1

271.2 201.4

381.5

171.1

383.0

239.0

732.6

388.7

258.9

291.8 313.6

444.3

332.7

365.1

262.8

382.3

380.5

250.9

300.3

435.8

350.4

391.2

319.5

192.6

303.9

300.1

162.2

371.4

231.6

Figure 3. Chlamydia — Rates by state: United States and outlying areas, 2005

Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico and

Virgin Islands) was 329.5 per 100,000 population. For further information on chlamydia

reporting, see Appendix (Chlamydia Morbidity Reporting).

Rate per 100,000

population

<=150.0 (n= 1,391)

150.1-300.0 (n= 950)

>300.0 (n= 799)

Figure 4. Chlamydia — Rates by county: United States, 2005
12 Chlamydia National Profile STD Surveillance 2005

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

0

150

300

450

600

750

1996 97 98 99 2000 01 02 03 04 05

Figure 5. Chlamydia — Cases by reporting source and sex: United States, 1996–2005

Rate (per 100,000 population)

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

0

320

640

960

1280

1600

1996 97 98 99 2000 01 02 03 04 05

Figure 6. Chlamydia — Rates by race/ethnicity: United States, 1996–2005
STD Surveillance 2005 National Profile Chlamydia 13

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

11.1

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

125.3

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

505.2

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2796.6

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

804.7

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2691.1

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

447.4

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

1080.4

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

204.1

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

384.6

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

110.7

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

160.4

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

60.5

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

64.3

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

25.4

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

23.2

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

8.4

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

6.8

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2.7

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2.3

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

161.6 Total

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total 498.2

Figure 7. Chlamydia — Age- and sex-specific rates: United States, 2005

Median state-specific positivity rate

0

2

4

6

8

10

1997 98 99 2000 01 02 03 04 05

Figure 8. Chlamydia — Median state-specific positivity among 15- to 24-year-old women

tested in family planning clinics: United States, 1997–2005

Note: As of 1997, all 10 Health and Human Services (HHS) regions, representing all 50 states,

the District of Columbia, and outlying areas, reported chlamydia positivity data. See

Appendix for definitions of HHS regions.
14 Chlamydia National Profile STD Surveillance 2005

Positivity (%)

Puerto Rico 5.4

Virgin Is. 20.3

<4.0

4.0-4.9

>=5.0

(n= 2)

(n= 10)

(n= 41)

VT 3.5

NH 4.1

MA 4.7

RI 6.9

CT 6.3

NJ 7.6

DE 7.5

MD 5.9

DC 5.8

8.1

5.5

6.9 6.1

6.0 6.1

4.5

8.9

8.1

4.9

7.2 7.6

5.2

5.7 5.6

8.0

4.2

8.3

7.4

15.5

6.9

5.4

4.8 4.3

9.8

4.7

7.9

4.9

7.5

6.1

4.2

5.8

11.4

5.3

6.9

9.0

12.2

7.4

6.7

3.0

8.3

6.3

Figure 9. Chlamydia — Positivity among 15- to 24-year-old women tested in family planning

clinics by state: United States and outlying areas, 2005

Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500

women aged 15-24 years screened during 2005.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

Region I

Region II

Region III

Region IV

Region V

Region VII Region VI

Region VIII

Region IX

Region X

6.4

01

6.1

02

5.5

03

5.4

04

5.5

05

9.8

01

9.1

02

10.2

03

9.7

04

7.8

05

7.2

01

6.8

02

6.9

03

7.5

04

7.4

05

10.4

01

10.1

02

9.6

03

10.9

04

11.0

05

8.0

01

8.2

02

8.7

03

8.8

04

9.0

05

11.5

01

11.8

02

11.7

03

11.7

04

11.5

05

6.1

01

6.5

02

6.5

03

6.8

04

6.8

05

7.1

01

7.4

02

7.3

03

7.6

04

7.4

05

8.8

01

8.0

02

8.5

03

8.5

04

8.1

05

6.2

01

6.7

02

7.5

03

7.7

04

7.4

05

IV

VII IX

I II

X

III

VI

V

VIII

Figure 10. Chlamydia — Trends in positivity among 15- to 24-year-old women tested in family

planning clinics by HHS region, 2001–2005

Note: Trends adjusted for changes in laboratory test method and associated increases in test

sensitivity. See Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring) for

more information. See Appendix for definitions of Health and Human Services (HHS) regions.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs;

Centers for Disease Control and Prevention
Gonorrhea

Background

Gonorrhea is the second most commonlyreported notifiable disease in the United

States. Infections due to Neisseria

gonorrhoeae, like those resulting from

Chlamydia trachomatis, are a major cause

of pelvic inflammatory disease (PID) in the

United States. PID can lead to serious

outcomes in women such as tubal infertility,

ectopic pregnancy, and chronic pelvic pain.

In addition, epidemiologic and biologic

studies provide strong evidence that

gonococcal infections facilitate the

transmission of HIV infection.1

From 1975 through 1997, the national

gonorrhea rate declined 74% following

implementation of the national gonorrhea

control program in the mid-1970s (Table 1).

Gonorrhea rates subsequently appeared to

plateau for several years. However, in 2005,

rates increased slightly from 2004 with

339,593 cases of gonorrhea reported in the

United States (Figure 11 and Table 1). True

increases or decreases may be masked by

changes in screening practices (affected by

concomitant testing for chlamydia and

broader use of urine-based testing), use of

diagnostic tests with differing test

performance, and changes in reporting

practices.2

For most areas, the number of gonorrhea

cases reported to CDC is affected by many

factors, in addition to the occurrence of the

infection within the population. As with

reporting of other STDs, reporting of

gonorrhea cases to CDC is incomplete.3 In

addition, reporting practices for gonococcal

infections may have been biased towards

reporting of infections in persons of

minority race or ethnicity, who are more

likely to attend public STD clinics.4 For

such reasons, supplemental data on

gonorrhea prevalence in persons screened

in a variety of different settings are useful in

assessing disease burden in selected

populations.

Gonorrhea – United States

In 2005, 339,593 cases of gonorrhea were

reported in the United States. The rate of

reported gonorrhea in the United States

was 115.6 cases per 100,000 population in

2005 (Figure 11 and Table 1), the first

increase in gonorrhea since 1999.

Gonorrhea by Region

As in previous years, in 2005 the South had

the highest gonorrhea rate among the four

regions of the country. However, the

gonorrhea rate in the South has declined

by 17.6% from a rate of 174.6 per 100,000

population in 2001 to 143.9 in 2005. Rates

in the Northeast have also declined 23.1%

from 2001 to 2005 (from 97.2 to 74.7). In

contrast, the gonorrhea rate in the West has

increased by 35.4% from 60.2 cases per

100,000 population in 2001 to 81.5 in

2005. The rate in the Midwest (142.5 in

2001 and 139.1 in 2005) has shown

minimal change since 2001. Of note,

however, is that gonorrhea rates in both the

Midwest and the South increased slightly

(4.0% and 1.6% respectively) from 2004 to

2005 (Figure 13 and Table 12).

Gonorrhea by State

In 2005, only states and Puerto Rico had

gonorrhea rates below the Healthy People

STD Surveillance 2005 National Profile Gonorrhea 15
2010 (HP2010) national target of 19 cases

per 100,000 population (Figure 14 and

Table 11).5

Gonorrhea by Metropolitan Statistical

Area (MSA)

The overall gonorrhea rate in the 50 most

populous MSAs was 128.2 cases per

100,000 population in 2005. This is a

3.9% increase from the prior year. All of

these MSAs had rates higher than the

HP2010 target of 19 cases per 100,000

population (Table 16). In 2005, 59.6% of

gonorrhea cases were reported by these

MSAs. Similar to previous years, in 2005

the total gonorrhea rate among females

in these MSAs (127.4) remained similar

to that among males (128.4) (Tables 17

and 18).

Gonorrhea by County

In 2005, 1,303 (41.5%) of 3,140 counties

in the United States had gonorrhea rates at

or below the HP2010 national target of 19

cases per 100,000 population. Rates per

100,000 population were between 19 and

100 in 1,118 counties (35.6%), and greater

than 100 in 719 counties (22.9%). The

majority of counties with greater than 100

cases per 100,000 population were located

in the South (Figure 15).

In 2005, 50% of reported gonorrhea cases

occurred in just 66 counties or independent

cities (Table 15).

Gonorrhea by Reporting Source

In 2005, 28.1% of gonorrhea cases were

reported by STD clinics. This is a change

from 2001, when 36.6% of gonorrhea cases

were reported by STD clinics (Table A2). In

2005, similar to previous years, a higher

proportion of male gonorrhea cases were

reported from STD clinics than female cases

(40.4% and 17.0% respectively) (Figure 16).

Gonorrhea by Region and Sex

From 2001 to 2005, gonorrhea rates

among women increased 41.4% in the

West, and decreased 23.0% in the

Northeast and 15.0% in the South. Over

the same time period, gonorrhea rates

among men increased 30.7% in the West,

and decreased 23.2% in the Northeast and

20.4% in the South (Tables 13 and 14).

Rates among both women and men in the

Midwest remained relatively unchanged

over this time period.

Gonorrhea by Sex

Prior to 1996, rates of gonorrhea among

men were higher than rates among women.

For the fifth straight year, however,

gonorrhea rates in women are slightly

higher than in men (Figure 12). In 2005 the

gonorrhea rate among women was 119.1

and the rate among men was 111.5 cases

per 100,000 population (Tables 13 and 14).

Gonorrhea by Race/Ethnicity

Changes in gonorrhea rates from 2001

through 2005 differed by racial/ethnic

group. Gonorrhea rates decreased by

17.8% during this time period for African

Americans from 762.0 to 626.4 cases per

100,000 population. In contrast, rates in

other racial/ethnic groups have increased.

Since 2001, the gonorrhea rate among

American Indian/Alaska Natives increased

28.4% (131.7 per 100,000 in 2005), whites

increased 19.7% (35.2 per 100,000 in

2005), Hispanics increased 6.4% (74.8 per

100,000 in 2005), and Asian/Pacific

Islanders increased 5.3% (25.9 per 100,000

in 2005) (Figure 17 and Table 20B).

In 2005, the gonorrhea rate among African

Americans was 18 times greater than the

rate for whites. This is a decrease from

2001 when there was a 26-fold difference

in rates. Gonorrhea rates were 3.7 times

greater among American Indian/Alaska

Natives, and 2.1 times greater among

Hispanics than among whites in 2005.

16 Gonorrhea National Profile STD Surveillance 2005
Gonorrhea by Age and Sex

In 2005, gonorrhea rates continued to be

highest among adolescents and young

adults. The overall gonorrhea rate was

highest for 20- to 24-year-olds (506.8),

which is over 4 times higher than the

national gonorrhea rate. Among females in

2005, 15- to 19- and 20- to 24-year-olds

had the highest rates of gonorrhea (624.7

and 581.2, respectively); among males, 20-

to 24-year-olds had the highest rate (436.8)

(Figure 18 and Table 19).

Although the gonorrhea rate among 15- to

19-year-olds decreased in recent years, in

2005 this rate increased 3.9%. Similar slight

increases were seen among 20- to 24-

year-olds and 25- to 29-year-olds (3.0%

and 4.3%) (Table 19). Increases over this

time period were similar among males 15-

to 19-years, 20- to 24-years, and 25- to

29-years (4.4%, 2.8%, and 3.8%

respectively) and among females 15- to

19-years, 20- to 24-years, and 25- to

29-years (3.6%, 3.2%, and 4.8%,

respectively) (Figures 19 and 20, and

Table 19).

Gonorrhea by Race/Ethnicity and Sex

From 2001 to 2005 the overall rate in

African-American men decreased 19.4%

from 826.8 per 100,000 population to

666.0. Decreases were seen in all age

groups of African-American men over this

time period. However, the overall rate in

white males increased 18.9% from 23.3 per

100,000 population in 2001 to 27.7 in

2005. Rates among American Indian/

Alaska Native men increased 44.1%,

Asian/Pacific Islander men increased

13.7%, and Hispanic men increased 2.6%

(Table 20B).

From 2001 to 2005 the overall rate among

African-American women decreased 16.1%

from 703.3 per 100,000 population to

590.4. Decreases were noted in 15- to

19-year-old African-American women

(18.3% from 2001 through 2005).

However, 15- to 19-year-old AfricanAmerican women still have the highest

gonorrhea rate of any group (2,814.0 per

100,000 population). Rates among white

women increased 20.4% from 35.3 per

100,000 population in 2001 to 42.5 in

2005. Increases were also seen among

American Indian/Alaska Native women

(21.4%) and Hispanic women (10.0%)

over this time period (Table 20B). The rate

among Asian/Pacific Islander women

remained essentially unchanged (1.9%

decrease).

Gonorrhea Prevalence Monitoring

Projects

Gonorrhea test positivity data are available

from a variety of settings. Screening criteria

and practices may vary by state.

Family Planning Clinics

In 2005, the median state-specific

gonorrhea test positivity among 15- to

24-year-old women screened in selected

family planning clinics in 41 states, Puerto

Rico, the District of Columbia, and the

Virgin Islands was 1.0% (range 0.0% to

3.8%) (Figure 21). Median gonorrhea

positivity in family planning clinics has

shown minimal change in recent years

(1.0% in 2001).

Prenatal Clinics

For women attending selected prenatal

clinics in 20 states, Puerto Rico, and the

Virgin Islands, the median positivity was

0.9% (range 0.0% to 3.2%) (Figure F).

Median gonorrhea positivity in prenatal

clinics has shown minimal change in recent

years (0.9% in 2001).

National Job Training Program

For 16- to 24-year-old women entering the

National Job Training Program in 32 states

and the District of Columbia in 2005, the

median state-specific gonorrhea prevalence

STD Surveillance 2005 National Profile Gonorrhea 17
was 2.4% (range 0.0% to 6.6%) in 2005

(Figure M). Among men entering the

program from 14 states in 2005, the

median state-specific gonorrhea positivity

was 2.2% (range 0.0% to 6.1%) (Figure N).

Juvenile Corrections

In 2005, the median positivity for

gonorrhea in women entering 38 juvenile

corrections facilities was 4.7% (range 0.9%

to 14.2%), and in men entering 65 juvenile

corrections facilities was 1.0% (range 0.0%

to 19.0%) (Table CC).

Gonococcal Isolate Surveillance

Project (GISP)

Antimicrobial resistance remains an

important consideration in the treatment

of gonorrhea. 109, 8 7 6 Overall, 19.6 % of

isolates collected in 2005 in 27 STD clinics

by the Gonococcal Isolate Surveillance

Project (GISP) were resistant to penicillin,

tetracycline, or both, up from 15.9% in

2004 (Figure 23).

Quinolone-resistant N. Gonorrhoeae

(QRNG)

Resistance to ciprofloxacin (a fluoroquinolone

in the quinolone family of antimicrobials) was

first identified in GISP sites in 1991. From

1991 through 1998, fewer than nine

quinolone-resistant N. gonorrhoeae (QRNG)

isolates were identified each year, and such

isolates were identified in only a few GISP

clinics. In 2000, similar to 1999, 19 (0.4%)

quinolone-resistant GISP isolates were

identified in seven GISP clinics. In 2001, 38

(0.7%) QRNG isolates were identified in six

clinics; in 2002, 116 (2.2%) such isolates

were identified in 13 clinics; in 2003, 270

(4.1%) were identified in 21 clinics; in 2004,

429 (6.8%) were identified in 24 clinics; and

in 2005, 581 (9.4%) isolates were submitted

and identified in 25 of the 27 clinics in GISP

demonstrating resistance to ciprofloxacin

(Figure 24).

QRNG by Region

In Honolulu, the prevalence of QRNG

identified remains high but has slightly

decreased from 2004. In 2005, 17 (19.3%)

of 88 isolates submitted from Honolulu

demonstrated ciprofloxacin-resistance,

down from 21 (22.8%) of 92 isolates in

2004.

In California, increases in the number of

isolates resistant to ciprofloxacin were

identified in four of five GISP sites, while

one site, Long Beach, experienced a slight

decrease from 25% in 2004 to 23.5% in

2005. Whereas, in Los Angeles, 14.5% of

isolates in 2005 were ciprofloxacin-resistant

compared with 13.8% in 2004; in Orange

County, 27.5% were resistant in 2005

compared to 20.5% in 2004; in San Diego,

26.2% were resistant in 2005 compared to

20.6% in 2004; and in San Francisco,

31.3% were resistant in 2005 compared to

24.3% in 2004.

Similarly in other West Coast sites,

Portland, Denver, and Las Vegas

experienced a substantial increase in

prevalence of QRNG, whereas Seattle

experienced a slight decrease. In Portland,

the prevalence of QRNG doubled to 23.1%

in 2005 from 11.5% in 2004; in Denver, to

10.9% in 2005 from 8.3% in 2004; and in

Las Vegas, to 5.4% in 2005 from 2.4% in

2004. In Seattle the prevalence dropped to

11.6% in 2005 from 16.2% in 2004. The

QRNG prevalence in Phoenix remained

relatively stable.

In the South, increases in prevalence of

QRNG occurred in Atlanta, Miami,

Oklahoma City, and New Orleans. In

Atlanta, QRNG resistance increased to

3.8% in 2005 from 0.9% in 2004; in

Miami, to 9.1% in 2005 from 6.8% in

2004; in Oklahoma City, to 2.3% in 2005

from 1.3% in 2004; and in New Orleans, to

6.3% in 2005 from 1.6% in 2004. (Note:

As a result of Hurricane Katrina, the 2005

prevalence for QRNG in New Orleans

contains isolates only from January–May

18 Gonorrhea National Profile STD Surveillance 2005

6-10
2005.) In Greensboro, the prevalence was

slightly down to 0.6% in 2005 from 0.8% in

2004; the prevalence in Dallas remained

the same.

In the Midwest and Northeast, there were

large increases in prevalence of QRNG seen

in Baltimore, Chicago, Cincinnati,

Cleveland, and Philadelphia. In Baltimore,

prevalence increased to 3% in 2005 from

1% in 2004; in Chicago to 4.7% in 2005

from 2.3% in 2004; in Cincinnati to 1% in

2005 from 0.3% in 2004; in Cleveland to

2.8% in 2005 from 0.4% in 2004; and in

Philadelphia, the prevalence quadrupled to

14.3% in 2005 from 3.3% in 2004. There

was a slight decrease in QRNG prevalence

in Minneapolis for 2005.

Sites that identified ciprofloxacin-resistant

isolates for the first time in 2005 include

Birmingham and Detroit. Only

Albuquerque and Tripler did not identify

QRNG isolates during 2005.

Overall, outside of Hawaii and California,

6.1% of isolates were ciprofloxacin-resistant

in 2005, an increase from 3.6% in 2004.

Additional information on antimicrobial

susceptibility data and treatment

recommendations from state and local

health departments may be found in the

2005 GISP report7 or the GISP website

(http://www.cdc.gov/std/GISP).

QRNG by Sexual Behavior

The number of QRNG isolates from men

who have sex with men (MSM) continued to

increase in 2005 to 387 (29% of all

specimens from MSM). During the same

time period, the number of these isolates

from heterosexuals increased from 136

(2.9%) in 2004 to 183 (3.8%) in 2005

(Figure 25).

As a result of this continued high prevalence

of quinolone-resistant N. gonorrhoeae in

California, Hawaii, among MSM, and the

increasing prevalence of QRNG in areas

other than the West Coast, in 2006 CDC

recommended that quinolones should not

be used for infections in MSM or in those

with a history of recent foreign travel or

partners’ travel, infections acquired in

California or Hawaii, or infections acquired

in other areas with increased QRNG

prevalence.10

Other Antimicrobial Susceptibility

Testing

To date, cephalosporin resistance has not

been identified in GISP, and the proportion

of GISP isolates demonstrating decreased

susceptibility to ceftriaxone or cefixime has

remained very low over time. In 2001,

three GISP isolates with decreased

susceptibility to cefixime were also found to

be resistant to penicillin, tetracycline, and

ciprofloxacin; such multi-drug resistance in

combination with decreased susceptibility

to cefixime had not previously been

identified in the United States.11 In 2004,

two GISP isolates had decreased

susceptibility to cefixime; one of those

isolates demonstrated the same resistance

pattern as the 2001 isolates described

above. In 2005, no GISP isolates had

decreased susceptibility to ceftriaxone or

cefixime.

The proportion of GISP isolates

demonstrating elevated minimum inhibitory

concentrations (MICs) to azithromycin has

been increasing since GISP began

monitoring azithromycin susceptibility in

1992. In 1992, there were no isolates with

azithromycin MIC 1.0 mg/ml but in 2004

there were 57 (0.9%) such isolates, and this

has now tripled to 181 (2.9%) in 2005.

However, caution is needed when

interpreting this increase, as a change in the

media used for antimicrobial susceptibility

testing in 2005 may have contributed to the

increase.

STD Surveillance 2005 National Profile Gonorrhea 19
Gonorrhea Among Special

Populations

Additional information about gonorrhea in

racial and ethnic minority populations,

adolescents, men who have sex with men,

and other at risk populations can be found

in the Special Focus Profiles.

Gonorrhea Summary

In summary, the national gonorrhea rate

increased in 2005 for the first time since

1999. Gonorrhea rates have declined

among African Americans, but increased in

all other racial and ethnic groups since

2001. However, rates among African

Americans remain markedly higher than

among other racial and ethnic groups.

Gonorrhea has increased in the West for

several years, and 2005 data now suggest

that these increases may be appearing in

the South and the Midwest as well. Rates

among adolescent and young adults had

been decreasing in recent years, but 2005

data now suggest possible increases in

these populations.

In addition, 2005 GISP data has shown

notable increases in QRNG prevalence,

especially in the Midwest and Northeast

regions where previously it had been lower.

As a response to these observations,

modifications were made in the 2006 CDC

STD Treatment Guidelines.10 Also, elevated

MICs for azithromycin have been observed

but the significance of this is yet to be

determined.

20 Gonorrhea National Profile STD Surveillance 2005

1 Fleming DT, Wasserheit JN. From

epidemiological synergy to public health policy

and practice: the contribution of other sexually

transmitted diseases to sexual transmission of

HIV infection. Sex Transm Infect, 1999

Feb;75(1):3-17.

2 Centers for Disease Control and Prevention.

Gonorrhea – United States, 1998. MMWR

2000;49:538-42.

3 Sexually Transmitted Diseases in America: How

Many Cases and At What Cost? Prepared for

the Kaiser Family Foundation by: American

Social Health Association, December 1998,

ASHA: Research Triangle Park, NC, Kaiser

Family Foundation: Menlo Park, CA 94025.

4 Fox KK, Whittington W, Levine WC, Moran JS,

Zaidi AA, Nakashima AN. Gonorrhea in the

United States, 1981–1996: demographic and

geographic trends. Sexually Transmitted

Diseases 1998;25(7):386-93.

5 U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

6 Centers for Disease Control and Prevention.

Fluoroquinolone-resistance in Neisseria

gonorrhoeae, Hawaii, 1999, and decreased

susceptibility to azithromycin in N. gonorrhoeae,

Missouri, 1999. MMWR 2000;49:833-837.

7 Centers for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance 2005

Supplement: Gonococcal Isolate Surveillance

Project (GISP) Annual Report 2005. Atlanta,

GA: U.S. Department of Health and Human

Services (available first quarter 2007).

8 Centers for Disease Control and Prevention.

Increases in fluoroquinolone-resistant Neisseria

gonorrhoeae – Hawaii and California, 2001

MMWR 2002;51:1041-1044.

9 Centers for Disease Control and Prevention.

Increases in fluoroquinolone-resistant Neisseria

gonorrhoeae among men who have sex with

men – United States, 2003, and revised

recommendations for gonorrhea treatment,

2004. MMWR 2004;53:335-338.

10Centers for Disease Control and Prevention.

Sexually Transmitted Diseases Treatment

Guidelines, 2006. MMWR, 2006;55(No.

RR-11).

11Wang SA, Lee MV, Iverson CJ, Ohye RG,

Whiticar PM, Hale JA, Trees DL, Knapp JS,

Effler PV, Weinstock HS. Multi-drug resistant

Neisseria gonorrhoeae with decreased

susceptibility to cefixime, Hawaii, 2001. CID

2003;37:849-52.
STD Surveillance 2005 National Profile Gonorrhea 21

Rate (per 100,000 population)

Gonorrhea

2010 Target

0

100

200

300

400

500

1941 46 51 56 61 66 71 76 81 86 91 96 2001

Figure 11. Gonorrhea — Rates: United States, 1941–2005 and the Healthy People 2010

target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

Rate (per 100,000 population)

Male

Female

Total

2010 Target

0

90

180

270

360

450

1986 88 90 92 94 96 98 2000 02 04

Figure 12. Gonorrhea — Rates: Total and by sex: United States, 1986–2005 and the

Healthy People 2010 target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.
22 Gonorrhea National Profile STD Surveillance 2005

Rate (per 100,000 population)

West

Midwest

Northeast

South

2010 Target

0

60

120

180

240

300

1996 97 98 99 2000 01 02 03 04 05

Figure 13. Gonorrhea — Rates by region: United States 1996–2005 and the Healthy People

2010 target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

Rate per 100,000

population

Guam 63.8

Puerto Rico 8.4

Virgin Is. 27.6

<=19.0

19.1-100.0

>100

(n= 7)

(n= 25)

(n= 21)

VT 9.7

NH 13.6

MA 39.5

RI 40.5

CT 78.5

NJ 65.8

DE 110.0

MD 126.6

207.6

91.5

86.2 162.6

95.7 70.1

116.3

179.6

81.1

8.5

157.5 129.8

54.4

95.2 70.8

212.0

10.8

174.9

68.3

247.0

164.3

17.0

66.3 123.4

81.5

92.1

176.5

20.2

183.1

148.4

43.5

90.5

203.9

45.5

145.8

116.1

30.4

111.9

60.3

42.4

106.5

17.2

Figure 14. Gonorrhea — Rates by state: United States and outlying areas, 2005

Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and

Virgin Islands) was 114.2 per 100,000 population. The Healthy People 2010 target is 19.0

cases per 100,000 population.
STD Surveillance 2005 National Profile Gonorrhea 23

Rate per 100,000

population

<=19.0 (n= 1,303)

19.1-100.0 (n= 1,118)

>100.0 (n= 719)

Figure 15. Gonorrhea — Rates by county: United States, 2005

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

0

40

80

120

160

200

1996 97 98 99 2000 01 02 03 04 05

Figure 16. Gonorrhea — Cases by reporting source and sex: United States, 1996–2005
24 Gonorrhea National Profile STD Surveillance 2005

Rate (per 100,000 population)

White

Black

Hispanic

Asian/PI

AI/AN

0

180

360

540

720

900

1996 97 98 99 2000 01 02 03 04 05

Figure 17. Gonorrhea — Rates by race/ethnicity: United States, 1996–2005

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

6.0

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

35.2

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

261.2

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

624.7

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

436.8

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

581.2

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

306.5

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

277.7

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

176.4

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

116.5

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

126.9

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

62.3

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

90.8

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

34.0

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

49.2

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

12.2

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

17.1

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2.5

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

4.2

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

0.6

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

111.8 Total

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total 119.4

Figure 18. Gonorrhea — Age- and sex-specific rates: United States, 2005
STD Surveillance 2005 National Profile Gonorrhea 25

Rate (per 100,000 population)

15-19 20-24

25-29 30-34

35-39 40-44

0

200

400

600

800

1,000

1996 97 98 99 2000 01 02 03 04 05

Figure 19. Gonorrhea — Age-specific rates among women 15 to 44 years of age:

United States, 1996–2005

Rate (per 100,000 population)

15-19 20-24

25-29 30-34

35-39 40-44

0

150

300

450

600

750

1996 97 98 99 2000 01 02 03 04 05

Figure 20. Gonorrhea — Age-specific rates among men 15 to 44 years of age: United

States, 1996–2005
26 Gonorrhea National Profile STD Surveillance 2005

Positivity (%)

Puerto Rico 0.4

Virgin Is. 3.0

See*

<1.0

1.0-1.9

>=2.0

(n= 9)

(n= 21)

(n= 17)

(n= 6)

VT 0.1

NH 0.4

MA

RI

CT 0.8

NJ 1.2

DE 1.2

MD

DC 1.9

1.6

0.6

0.9 1.6

1.1 0.5

0.8

2.1

0.7

1.4 1.1

0.6

0.7 0.6

1.9

0.0

3.8

1.1

2.8

1.2

1.2

0.5 0.6

1.3

0.6

1.5

1.7

0.7 2.1

0.9

1.5

0.7

1.0

0.4

4.2

0.2

Figure 21. Gonorrhea — Positivity among 15- to 24-year-old women tested in family planning

clinics by state: United States and outlying areas, 2005

*States/areas not meeting minimum inclusion criteria.

Note: Includes states and outlying areas that reported positivity data on at least 500 women aged

15-24 years screened during 2006.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

STD Clinics

Clinics and

Regional Labs

Birmingham Phoenix

Long Beach Los Angeles

Orange Co.

San Diego

San Francisco Denver

Miami

Atlanta

Honolulu

Tripler AMC

Chicago

New Orleans

Baltimore

Detroit Minneapolis

Las Vegas

Albuquerque

Greensboro

Cincinnati

Cleveland

Oklahoma City

Portland

Philadelphia

Dallas

Seattle

Figure 22. Gonococcal Isolate Surveillance Project (GISP) — Location of participating

clinics and regional laboratories: United States, 2005

.
STD Surveillance 2005 National Profile Gonorrhea 27

Susceptible

PPNG

TRNG

PPNG/TRNG

PenR

TetR

CMRNG

80.4%

0.5%

4.5%

0.7%

1.9%

5.9%

6.1%

Figure 23. Gonococcal Isolate Surveillance Project (GISP) — Penicillin and tetracycline

resistance among GISP isolates, 2005

Note: PPNG=penicillinase-producing N. gonorrhoeae; TRNG=plasmid-mediated tetracyclineresistant N. gonorrhoeae; PPNG-TRNG=plasmid-mediated penicillin and tetracycline-resistant

N. gonorrhoeae; PenR=chromosomally mediated penicillin-resistant N. gonorrhoeae; TetR=

chromosomally mediated tetracycline-resistant N. gonorrhoeae; CMRNG=chromosomally

mediated penicillin- and tetracycline-resistant N. gonorrhoeae.

Percent

Resistant

Intermediate resistance

0.0

3.0

6.0

9.0

12.0

1990 91 92 93 94 95 96 97 98 99 2000 01 02 03 04 05

Figure 24. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance or intermediate resistance to

ciprofloxacin, 1990–2005

Note: Resistant isolates have ciprofloxacin MICs  1 g/ml. Isolates with intermediate resistance

have ciprofloxacin MICs of 0.125 - 0.5 g/ml. Susceptibility to ciprofloxacin was first

measured in GISP in 1990.
28 Gonorrhea National Profile STD Surveillance 2005

Percent Ciprofloxacin Resistant

Heterosexual men

Men who have sex with men (MSM)

0

5

10

15

20

25

30

2001 2002 2003 2004 2005

Figure 25. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior,

2001–2005
Syphilis

Background

Syphilis, a genital ulcerative disease, causes

significant complications if untreated and

facilitates the transmission of HIV.

Untreated early syphilis in pregnant women

results in perinatal death in up to 40% of

cases and, if acquired during the four years

preceding pregnancy, may lead to infection

of the fetus in over 70% of cases.1

The rate of primary and secondary (P&S)

syphilis reported in the United States

decreased during the 1990s; in 2000, the

rate was the lowest since reporting began in

1941 (Figure 26). The low rate of infectious

syphilis and the concentration of the

majority of syphilis cases in a small number

of geographic areas in the United States led

to the development of the CDC’s National

Plan to Eliminate Syphilis, which was

announced by Surgeon General David

Satcher in October 1999 and revised in

May 2006.2 Collaboration with diverse

organizations, public health professionals,

the private medical community, and other

partners working in the fields of STD and

HIV is essential for the successful

elimination of syphilis in the United States.3

Although the rate of P&S syphilis in the

United States declined 89.7% between

1990 and 2000, the rate of P&S syphilis

increased from 2001 to 2005. Overall

increases in rates between 2001 and 2005

were observed primarily among men. In

2005, for the first time in over 10 years, the

rate of primary and secondary syphilis

among women increased from 0.8 cases

per 100,000 population in 2003 and 2004

to 0.9 cases per 100,000 population.

Despite national progress toward syphilis

elimination, syphilis remains an important

problem in the South and in urban areas in

other regions of the country. Increases

among men who have sex with men have

occurred at least since 2000 and continue

through 2005. These men have been

characterized by high rates of HIV

co-infection and high-risk sexual

behavior.4,5,6,7,8,9,10,11

Syphilis – All Stages (P&S, Early

Latent, Late, Late Latent,

Congenital)

Between 2004 and 2005, the number of

cases of early latent syphilis reported to

CDC increased 5.3% (from 7,768 to

8,176), while the number of cases of late

and late latent syphilis decreased 7.2%

(from 17,300 to 16,049) (Table 1). The

total number of cases of syphilis (all stages:

P&S, early latent, late, late latent, and

congenital syphilis) reported to CDC

decreased 0.4% (from 33,419 to 33,278)

between 2004 and 2005 (Table 1).

P&S Syphilis – United States

In 2005, P&S syphilis cases reported to

CDC increased to 8,724 from 7,980 in

2004, an increase of 9.3%. The rate of P&S

syphilis in the United States in 2005 (3.0

cases per 100,000 population) was 11.1%

higher than the rate in 2004 (2.7 cases per

100,000 population), and it is greater than

the HP 2010 target of 0.2 case per 100,000

population (Figure 26, Table 1).12 Between

2004 and 2005, P&S syphilis rates in most

age groups increased. (Table 31).

STD Surveillance 2005 National Profile Syphilis 29

4-11
P&S Syphilis by Region

The South accounted for 46.4% of P&S

syphilis in 2005 and 47.5% in 2004.

Between 2004 and 2005, rates increased

in all U.S. regions; rates increased 5.6% in

the South (from 3.6 to 3.8 cases per

100,000 population), 4.5% in the

Northeast (from 2.2 to 2.3), 14% in the

West (from 2.9 to 3.3); and 13% in the

Midwest (from 1.6 to 1.8). The 2005 rates

in all regions were greater than the HP

2010 target of 0.2 case per 100,000

population (Figure 28, Table 24).

P&S Syphilis by State

In 2005, P&S syphilis rates in six states

and no outlying areas were less than or

equal to the HP 2010 target of 0.2 case

per 100,000 population (Figure 29, Table

23). Seven states and two outlying areas

reported five or fewer cases of P&S

syphilis in 2005 (Table 23).

P&S Syphilis by County

In 2005, 2,434 of 3,140 counties (77.5%)

in the United States reported no cases of

P&S syphilis compared with 2,488 (79.3%)

counties reporting no cases in 2004. Of 706

counties reporting at least one case of P&S

syphilis in 2005, 5 (0.7%) had rates at or

below the HP2010 target of 0.2 case per

100,000 population. Rates of P&S syphilis

were above the HP2010 target for 701

counties in 2005 (Figure 30). These 701

counties (22.3% of the total number of

counties in the United States) accounted for

99.9% of the total P&S syphilis cases

reported in 2005.

In 2005, half of the total number of P&S

syphilis cases were reported from 19

counties and two cities (Table 27).

P&S Syphilis by MSA

The rate of P&S syphilis in 2005 for the 50

most populous MSAs (4.5) exceeded the

HP 2010 target of 0.2 case per 100,000

population (Table 28).

P&S Syphilis by Reporting Source

Between 1990 and 2005, the proportion of

P&S syphilis cases reported from sources

other than STD clinics increased from 25.6%

to 68.7% (Figure 31, Table A2). Between

2001 and 2005, the number of cases among

males reported from non-STD clinic sources

increased sharply while the number from

STD clinics remained stable (Figure 31).

P&S Syphilis by Sex

The rate of P&S syphilis increased 8.5%

among men (from 4.7 cases to 5.1 cases

per 100,000 men) between 2004 and 2005

(Figure 27, Table 26). During this time, the

rate increased among women from 0.8 to

0.9 cases per 100,000 women (Figure 27,

Table 25).

P&S Syphilis by Male to Female Rate

Ratio

The male-to-female rate ratio for P&S

syphilis has risen steadily since 1996 when

it was 1.2 (Figure 33), suggesting an

increase in syphilis among MSM during this

time. The male-to-female rate ratio in 2005

was 5.7.

Between 2004 and 2005, the male-tofemale rate ratio for P&S syphilis increased

among whites (from 10 to 11), African

Americans (from 3.3 to 3.6) Asian/Pacific

Islanders (from 11 to 12), and American

Indians/Alaska Natives (from 1.3 to 2.1).

The male-to-female rate ratio decreased

among Hispanics (from 7.7 to 6.1) (Table

32B).

An increase in the male-to-female rate ratio

for P&S syphilis occurred in the District of

Columbia, Puerto Rico and in 18 of 33

states (55%) that reported at least 25 cases

in 2005.

30 Syphilis National Profile STD Surveillance 2005
P&S Syphilis by Race/Ethnicity and

Sex

From 2004 to 2005, the rate among

non-Hispanic whites increased 12.5% (from

1.6 to 1.8); rates among men increased

10% (from 3.0 to 3.3) and stayed the same

among women (0.3). The rate among

African Americans increased 11.4% (from

8.8 to 9.8); rates among men increased

12.9% (from 13.9 to 15.7), and rates

among women increased 4.8% (from 4.2 to

4.4). The rate among Hispanics increased

6.5% (from 3.1 to 3.3); rates among men

increased 1.9% (from 5.4 to 5.5), and rates

among women increased 28.6% (from 0.7

to 0.9). The rate among Asian/Pacific

Islanders stayed the same (1.2); rates

among men increased 4.5% (from 2.2 to

2.3) and stayed the same among women

(0.2). The rate among American

Indian/Alaska Natives decreased 22.6%

(from 3.1 to 2.4); rates among men

decreased 5.7% (from 3.5 to 3.3), and rates

among women decreased 42.9% (from 2.8

to 1.6) (Figure 32, Table 32B).

In 2005, the rate of P&S syphilis reported

among African Americans (9.8 cases per

100,000 population) was 5.4 times higher

than the rate among non-Hispanic whites

(1.8 cases per 100,000 population),

reflecting an overall decrease in disparity

during the last several years (Table 32B).

P&S Syphilis by Race/Ethnicity, Age,

and Sex

In 2005, the rate of P&S syphilis among

African Americans was highest among

women aged 20-24 years (13.5) and

among men aged 25-29 years (38.2). For

non-Hispanic whites, the rate was highest

among women aged 20-24 years (0.8) and

among men aged 35-39 years (10.3). For

Hispanics, the rate was highest among

women aged 20-24 years (2.9) and among

men aged 35-39 years (14.0). For

Asian/Pacific Islanders, the rate was highest

among women aged 20-24 years (0.8) and

among men aged 30-34 years (6.6). For

American Indian/Alaska Natives, the rate

was highest among women aged 35-39

years (4.7) and among men aged 30-34

years (11.4) (Table 32B).

Congenital Syphilis – United States

Between 2004 and 2005, the overall rate of

congenital syphilis decreased 12.1% in the

United States, from 9.1 to 8.0 cases per

100,000 live births (Figure 37, Table 37).

The continuing decline in the rate of

congenital syphilis (Figure 38) likely reflects

the substantial reduction in the rate of P&S

syphilis among women that has occurred

during the last decade (Figure 37).13,14

Between 1996 and 2005, the average yearly

percentage decrease in the congenital

syphilis rate was 14.1% (Table 37). The

average yearly percentage decrease in the

rate of P&S syphilis among women between

1996 and 2005 was 14.1%. Overall, there

has been a 74% decrease in cases of

congenital syphilis since 1996.

Congenital Syphilis by State

In 2005, 26 states and two outlying areas

had rates of congenital syphilis that

exceeded the HP 2010 target of one case

per 100,000 live births (Tables 38-39).

Syphilis Among Special Populations

Additional information about syphilis and

congenital syphilis in racial and ethnic

minority populations, adolescents, men

who have sex with men, and other at risk

populations can be found in the Special

Focus Profiles.

STD Surveillance 2005 National Profile Syphilis 31
32 Syphilis National Profile STD Surveillance 2005

1 Ingraham NR. The value of penicillin alone in

the prevention and treatment of congenital

syphilis. Acta Derm Venereol 31 (suppl

24):60,1951.

2 Division of STD Prevention. The National Plan

to Eliminate Syphilis from the United States.

National Center for HIV, STD, and TB

Prevention, Centers for Disease Control and

Prevention, 2006.

3 Centers for Disease Control and Prevention.

Primary and secondary syphilis – United States,

2003–2004. MMWR 2006;55:269-73.

4 Centers for Disease Control and Prevention.

Resurgent bacterial sexually transmitted disease

among men who have sex with men – King

County, Washington, 1997–1999. MMWR

1999;48:773-777.

5 Centers for Disease Control and Prevention.

Outbreak of syphilis among men who have sex

with men – Southern California, 2000. MMWR

2001;50(7):117-20.

6 Bronzan R, Echavarria L, Hermida J, Trepka M,

Burns T, Fox, K. Syphilis among men who have

sex with men (MSM) in Miami – Dade County,

Florida [Abstract no. P135]. In: Program and

abstracts of the 2002 National STD Prevention

Conference, San Diego, California, March 4-7,

2002.

7 Centers for Disease Control and Prevention.

Primary and secondary syphilis among men

who have sex with men – New York City, 2001.

MMWR 2002;51:853-6.

8 Chen SY, Gibson S, Katz MH, Klausner JD,

Dilley JW, Schwarcz SK, Kellogg TA, McFarland

W. Continuing increases in sexual risk behavior

and sexually transmitted diseases among men

who have sex with men: San Francisco,

California, 1999–2001 [Letter]. Am J Public

Health 2002;92:1387-8.

9 Ciesielski CA, Boghani S. HIV infection among

men with infectious syphilis in Chicago,

1998–2000 [Abstract no. 12]. In: Program and

abstracts of the 9th Conference on Retroviruses

and Opportunistic Infections, Seattle,

Washington, February 24-28, 2002.

10D'Souza G, Lee JH, Paffel JM. Outbreak of

syphilis among men who have sex with men in

Houston, Texas. Sexually Transmitted Diseases

2003;30:872-3.

11Robinson BC, Chiliade PA, Lee C, Bautista J,

Saenz G. Redirecting elimination efforts in

response to the changing epidemiology of

syphilis [Abstract no. 167]. In: Program and

abstracts of the 2004 National STD Prevention

Conference, Philadelphia, Pennsylvania, March

8-11, 2004.

12U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

13Centers for Disease Control and Prevention.

Congenital syphilis – United States, 2002.

MMWR 2004;53:716-9.

14Centers for Disease Control and Prevention.

Primary and secondary syphilis – United States,

2002. MMWR 2003;52(46):1117-20.
STD Surveillance 2005 National Profile Syphilis 33

Cases (in thousands)

P&S

Early Latent

Total Syphilis

0

120

240

360

480

600

1941 46 51 56 61 66 71 76 81 86 91 96 2001

Figure 26. Syphilis — Reported cases by stage of infection: United States, 1941–2005

Rate (per 100,000 population)

Male

Female

Total

2010 Target

0

5

10

15

20

25

1986 88 90 92 94 96 98 2000 02 04

Figure 27. Primary and secondary syphilis — Rates: Total and by sex: United States,

1986–2005 and the Healthy People 2010 target

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population.
34 Syphilis National Profile STD Surveillance 2005

Rate (per 100,000 population)

West

Midwest

Northeast

South

2010 Target

0

2

4

6

8

10

1996 97 98 99 2000 01 02 03 04 05

Figure 28. Primary and secondary syphilis — Rates by region: United States, 1996–2005

and the Healthy People 2010 target

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population.

Rate per 100,000

population

Guam 1.2

Puerto Rico 5.8

Virgin Is. 0.9

<=0.2

0.21-4.0

>4.0

(n= 6)

(n= 39)

(n= 8)

VT 0.2

NH 1.2

MA 1.9

RI 2.2

CT 1.7

NJ 1.5

DE 1.3

MD 5.6

3.7

1.4

3.0 1.9

4.4 1.0

4.2

7.3

0.9

1.4

4.1 1.0

0.3

0.7 1.3

6.2

0.1

1.0

1.4

1.7

2.6

0.8

0.2 4.7

2.9

3.7

3.2

0.2

1.8

1.2

1.1

1.6

2.0

0.3

3.7

3.9

0.4

1.9

2.5

0.2

0.7

0.0

Figure 29. Primary and secondary syphilis — Rates by state: United States and outlying

areas, 2005

Note: The total rate of P&S syphilis for the United States and outlying areas (Guam, Puerto Rico and

Virgin Islands) was 3.0 per 100,000 population. The Healthy People 2010 target is 0.2 case per

100,000 population.
STD Surveillance 2005 National Profile Syphilis 35

Rate per 100,000

population

<=0.2 (n= 2,439)

0.3-4.0 (n= 506)

>4.0 (n= 195)

Figure 30. Primary and secondary syphilis — Rates by county: United States, 2005

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. In 2005,

2,434 (77.5%) of 3,140 counties in the U.S. reported no cases of P&S syphilis.

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

0

1

2

3

4

5

1996 97 98 99 2000 01 02 03 04 05

Figure 31. Primary and secondary syphilis — Cases by reporting source and sex:

United States, 1996–2005
36 Syphilis National Profile STD Surveillance 2005

Rate (per 100,000 population)

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

0

8

16

24

32

40

1996 97 98 99 2000 01 02 03 04 05

Figure 32. Primary and secondary syphilis — Rates by race/ethnicity: United States,

1996–2005

Male-Female rate ratio

0

2:1

4:1

6:1

8:1

10:1

1996 97 98 99 2000 01 02 03 04 05

Figure 33. Primary and secondary syphilis — Male-to-female rate ratios: United States,

1996–2005
STD Surveillance 2005 National Profile Syphilis 37

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

0.0

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

0.1

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2.4

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

1.9

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

8.1

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

3.0

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

10.1

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2.1

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

11.4

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

1.5

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

13.2

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

1.7

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

10.9

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

1.4

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

5.3

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

0.5

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

2.0

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

0.1

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

0.4

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

0.0

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

5.1 Total

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total 0.9

Figure 34. Primary and secondary syphilis — Age- and sex-specific rates: United States, 2005

Rate (per 100,000 population)

15-19

20-24

25-29

30-34

35-39

40-44

0

3

6

9

12

15

1996 97 98 99 2000 01 02 03 04 05

Figure 35. Primary and secondary syphilis — Age-specific rates among women 15 to 44

years of age: United States, 1996–2005
38 Syphilis National Profile STD Surveillance 2005

Rate (per 100,000 population)

15-19

20-24

25-29

30-34

35-39

40-44

0

3

6

9

12

15

1996 97 98 99 2000 01 02 03 04 05

Figure 36. Primary and secondary syphilis — Age-specific rates among men 15 to 44 years

of age: United States, 1996–2005

CS cases (in thousands) P&S rate (per 100,000 women)

P&S Syphilis

0.0

0.4

0.8

1.2

1.6

1996 97 98 99 2000 01 02 03 04 05

0

1

2

3

4

Figure 37. Congenital syphilis (CS) — Reported cases for infants < 1 year of age and rates

of primary and secondary syphilis among women: United States, 1996–2005
STD Surveillance 2005 National Profile Syphilis 39

Rate (per 100,000 live births)

Congenital Syphilis

2010 Target

0

10

20

30

40

50

1996 97 98 99 2000 01 02 03 04 05

Figure 38. Congenital syphilis — Rates for infants < 1 year of age: United States,

1996–2005 and the Healthy People 2010 target

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births.

Other Sexually Transmitted

Diseases

Chancroid

Since 1987, reported cases of chancroid

declined steadily until 2001 when 38 cases

were reported (Figure 39, Table 1). In 2005,

17 cases of chancroid were reported in the

United States, the lowest number of cases

ever reported. Only 10 states and one

outlying area reported one or more cases of

chancroid in 2005 (Table 41). Although the

overall decline in reported chancroid cases

most likely reflects a decline in the

incidence of this disease, these data should

be interpreted with caution since

Haemophilus ducreyi, the causative

organism of chancroid, is difficult to culture

and, as a result, this condition may be

substantially under diagnosed.1,2

Human Papillomavirus

Persistent infection with high risk human

papillomavirus (HR-HPV) can lead to

development of anogenital cancers (i.e.

cervical cancer). Sentinel surveillance for

cervical infection with high-risk human

papillomavirus types 16, 18, 31, 33, 35,

39, 45, 51, 52, 56, 58, 59, 68 was

conducted in 29 STD, family planning and

primary care clinics in six locations (Boston,

Baltimore, New Orleans, Denver, Seattle

and Los Angeles) as part of an effort to

estimate national burden of disease and

inform prevention programs such as

vaccine programs in the U.S. Testing was

performed using a commercially available

test for HR-HPV testing (Digene Hybrid

Capture 2, Gaithersburg). Interim results

from 2003–2004 document an overall

HR-HPV prevalence of 22.5%. Prevalence

in STD clinics was 28%, 24% in family

planning clinics, and 16% in primary care

clinics. Prevalence by age group was:

14-19 years 35%; 20-29 years 29%; 30-39

years 14%; 40-49 years 12%; and 50-65

years 6%.

In June 2006, a quadrivalent HPV vaccine

was licensed for use in the United States.

The vaccine provides protection against

types 6, 11, 16, and 18. PCR based

HR-HPV testing and typing using the

Roche line blot assay provided

type-specific estimates of prevalence for

types 16 and 18, two types contained in

the HPV vaccine. Overall prevalence of

HPV 16/18 was 8%. Prevalence of HPV

16/18 by age group was: 14-19 years

16%; 20-29 years 10%; 30-39 years 3%;

40-49 years 2%; 50-65 years 1%.3,4

Pelvic Inflammatory Disease

For data on Pelvic Inflammatory Disease

(PID), see the Special Focus Profile on

Women and Infants.

Other Sexually Transmitted Diseases

Case reporting data for genital herpes

simplex virus (HSV), genital warts or other

human papillomavirus infections, and

trichomoniasis are not available. Trend data

are limited to estimates of the initial office

visits in physicians’ office practices for these

conditions from the National Disease and

Therapeutic Index (NDTI) (Figures 40-42

and Table 42).

STD Surveillance 2005 National Profile Other Sexually Transmitted Diseases 41
42 Other Sexually Transmitted Diseases National Profile STD Surveillance 2005

1 Schulte JM, Martich FA, Schmid GP. Chancroid

in the United States, 1981–1990: Evidence for

underreporting of cases. MMWR 1992;41(no.

SS-3):57-61.

2 Mertz KJ, Trees D, Levine WC, et al. Etiology of

genital ulcers and prevalence of human

immunodeficiency virus coinfection in 10 US

cities. J Infect Dis 1998;178:1795-8.

3 Datta SD, Koutsky L, Douglas J, et al. Sentinel

surveillance for human papillomavirus among

women in the United States, 2003–2004

[Abstract no. MO-306]. In: Program and

abstracts of the 16th Biennial Meeting of the

International Society for Sexually Transmitted

Diseases Research, Amsterdam, The

Netherlands, July 10-13, 2005

4 Datta SD, Koutsky L, Ratelle S, et al.

Type-Specific High-Risk HPV Prevalence from

the HPV Sentinel Surveillance Project, US,

2003–2005 [Abstract no. P-099]. In Program

and abstracts of the International Human

Papillomavirus Meeting, Prague, Czech

Republic, September 2006.
STD Surveillance 2005 National Profile Other Sexually Transmitted Diseases 43

Cases (in thousands)

0

1

2

3

4

5

1981 83 85 87 89 91 93 95 97 99 2001 03 05

Figure 39. Chancroid — Reported cases: United States, 1981–2005

sits (in thousands)

0

60

120

180

240

300

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Figure 40. Genital herpes — Initial visits to physicians’ offices: United States, 1966–2005

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for genital

herpes estimates range from 20% to 30%.

SOURCE: National Disease and Therapeutic Index (IMS Health)
44 Other Sexually Transmitted Diseases National Profile STD Surveillance 2005

Visits (in thousands)

0

80

160

240

320

400

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Figure 41. Genital warts — Initial visits to physicians’ offices: United States, 1966–2005

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for genital

warts estimates range from 20% to 40%.

SOURCE: National Disease and Therapeutic Index (IMS Health)

its (in thousands)

Trichomoniasis

Other Vaginitis

0

900

1,800

2,700

3,600

4,500

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Figure 42. Trichomoniasis and other vaginal infections in women — Initial visits to

physicians’ offices: United States, 1966–2005

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for

trichomoniasis estimates range from 7.5% to 13% and for other vaginitis estimates range

from 16% to 30%.

SOURCE: National Disease and Therapeutic Index (IMS Health)
SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
Special Focus Profiles

The Special Focus Profiles highlight trends

and distribution of sexually transmitted

diseases (STDs) in populations of particular

interest for STD and HIV prevention programs

in state and local health departments. These

populations are most vulnerable to STDs and

their consequences: women and infants,

adolescents and young adults, minorities,

men who have sex with men (MSM), and

persons entering corrections facilities. The

Special Focus Profiles refer to figures

located in disease-specific sections in the

National Profile and additional figures

and tables (Figures A-FF and Tables AA-FF)

that highlight specific points made in the

text.

STD Surveillance 2005 Special Focus Profiles 45

STDs in Women and Infants

Public Health Impact

Women and infants disproportionately bear

the long term consequences of STDs.

Women infected with Neisseria gonorrhoeae

or Chlamydia trachomatis can develop

pelvic inflammatory disease (PID), which, in

turn, may lead to reproductive system

morbidity such as ectopic pregnancy and

tubal factor infertility. If not adequately

treated, 20% to 40% of women infected

with chlamydia1 and 10% to 40% of women

infected with gonorrhea2 may develop PID.

Among women with PID, tubal scarring can

cause involuntary infertility in 20%, ectopic

pregnancy in 9%, and chronic pelvic pain in

18%.3 Approximately 70% of chlamydia

infections and 50% of gonococcal infections

in women are asymptomatic.4,5,6These

infections are detected primarily through

screening programs. The vague symptoms

associated with chlamydial and gonococcal

PID cause 85% of women to delay seeking

medical care, thereby increasing the risk of

infertility and ectopic pregnancy.7 Data from

a randomized controlled trial of chlamydia

screening in a managed care setting suggest

that such screening programs can reduce the

incidence of PID by as much as 60%.8

Gonorrhea and chlamydia can also result in

adverse outcomes of pregnancy, including

neonatal ophthalmia and, in the case of

chlamydia, neonatal pneumonia. Although

topical prophylaxis of infants at delivery is

effective for prevention of ophthalmia

neonatorum, prevention of neonatal

pneumonia requires prenatal detection and

treatment.

Human papillomavirus (HPV) infections are

highly prevalent, especially among young

sexually active women. While the great

majority of HPV infections in women

resolve within one year, they are a major

concern because persistent infection with

specific types (e.g., types 16, 18, 31, 33,

35, and 45), are causally related to cervical

cancer; these types also cause Pap smear

abnormalities. Other types (e.g., types 6

and 11) cause genital warts, low grade Pap

smear abnormalities and, rarely, recurrent

respiratory papillomatosis in infants born

to infected mothers.9

Genital infections with herpes simplex virus

are extremely common, may cause painful

outbreaks, and may have serious

consequences for pregnant women

including potentially fatal neonatal

infections.10

When a woman has a syphilis infection

during pregnancy, she may transmit the

infection to the fetus in utero. This may

result in fetal death or an infant born with

physical and mental developmental

disabilities. Most cases of congenital

syphilis are easily preventable if women

are screened for syphilis and treated early

during prenatal care.11

Observations

Chlamydia – United States

Between 2004 and 2005, the rate of

chlamydia infections in women increased

from 480.6 to 496.5 per 100,000

females (Figure 1, Table 4). Chlamydia

rates exceed gonorrhea rates among

women in all states (Figures A and B,

Tables 4 and 13).

STD Surveillance 2005 Special Focus Profiles STDs in Women and Infants 47

4-6
Chlamydia – Infertility Prevention

Program

In 2005, the median state-specific chlamydia

test positivity among 15- to 24-year-old

women tested in selected prenatal clinics in

25 states, Puerto Rico, and the Virgin Islands

was 8.0% (range 2.8% to 16.9%) (Figure E).

In 2005, the median state-specific chlamydia

test positivity among 15- to 24-year-old

women who were screened during visits to

selected family planning clinics in all states

and outlying areas was 6.3% (range 3.0% to

20.3%) (Figures 8 and 9).

Gonorrhea – United States

Gonorrhea rates among women were higher

than the overall HP 2010 target of 19.0

cases per 100,000 population12 in 46 states

and two outlying areas in 2005 (Figure B,

Table 13).

Like chlamydia, gonorrhea is often

asymptomatic in women. Gonorrhea

screening, therefore, is an important strategy

for the identification of gonorrhea among

women. Large-scale screening programs for

gonorrhea in women began in the 1970s.

After an initial increase in cases detected

through screening, gonorrhea rates for both

women and men declined steadily

throughout the 1980s and early 1990s, and

then reached a plateau (Figure 11). The

gonorrhea rate for women (119.1 per

100,000 females) increased slightly in 2005.

Although the gonorrhea rate in men has

historically been higher than the rate in

women, the gonorrhea rate among women

has been higher than the rate among men

for five consecutive years (Figure 12 and

Tables 13 and 14).

Gonorrhea – Infertility Prevention

Program

In 2005, the median state-specific

gonorrhea test positivity among 15- to

24-year- old women screened in selected

family planning clinics in 41 states, Puerto

Rico, the District of Columbia, and the

Virgin Islands was 1.0% (range

0.0%-3.8%) (Figure 21). Median

gonorrhea positivity in family planning

clinics has shown minimal change in recent

years (1.0% in 2001).

In 2005, the median state-specific

gonorrhea test positivity among 15- to

24-year- old women screened in selected

prenatal clinics in 20 states, Puerto Rico,

and the Virgin Islands was 0.9% (range

0.0% to 3.2%) (Figure F). Median

gonorrhea positivity in prenatal clinics has

shown minimal change in recent years

(0.9% in 2001).

Primary and Secondary Syphilis by

State

The HP 2010 target for primary and

secondary (P&S) syphilis is 0.2 case per

100,000 population. In 2005, 29 states

and two outlying areas had rates of P&S

syphilis for women that were greater

than 0.2 case per 100,000 population

(Table 25).

Congenital Syphilis

The HP 2010 target for congenital syphilis

is 1.0 case per 100,000 live births. In

2005, 26 states, Guam, and Puerto Rico

had rates higher than this target (Table 38).

The number of congenital syphilis cases

closely follows the trend of P&S syphilis

among women (Figure 37). Peaks in

congenital syphilis usually occur one year

after peaks in P&S syphilis among

women. The congenital syphilis rate

peaked in 1991 at 107.3 cases per

100,000 live births, and declined by

92.5% to 8.0 cases per 100,000 live

births in 2005 (Figure 38, Table 37). The

rate of P&S syphilis among women

declined 94.8% (from 17.3 to 0.9 cases

per 100,000 females) during 1990–2005

(Figure 27).

48 STDs in Women and Infants Special Focus Profiles STD Surveillance 2005
The 2005 rate of congenital syphilis for the

United States is currently eight times higher

than the HP2010 target of 1.0 case per

100,000 live births.

While most cases of congenital syphilis

occur among infants whose mothers have

had some prenatal care, late or limited

prenatal care has been associated with

congenital syphilis. Failure of health care

providers to adhere to maternal syphilis

screening recommendations also contributes

to the occurrence of congenital syphilis.13

Pelvic Inflammatory Disease

Accurate estimates of pelvic inflammatory

disease (PID) and tubal factor infertility

resulting from gonococcal and chlamydia

infections are difficult to obtain. Definitive

diagnosis of these conditions can be

complex.

Hospitalizations for PID have declined

steadily throughout the 1980s and early

1990s, but have remained relatively

constant between 1995 and 2004 (Figure

H). A greater proportion of women

diagnosed with PID in the 1990s have been

treated in outpatient instead of inpatient

settings when compared to women

diagnosed with PID in the 1980s.14

The estimated number of initial visits to

physicians’ offices for PID from the National

Disease and Therapeutic Index (NDTI) has

generally declined from 1993 through 2005

(Figure I and Table 42).

In 2003, an estimated 168,837 cases of

PID were diagnosed in emergency

departments among women 15 to 44

years of age. In 2004 this estimate

increased to 170,076 (National Hospital

Ambulatory Medical Care Survey, NCHS).

As of the date of publication of this report,

2005 data are not available.

Ectopic Pregnancy

Evidence suggests that health care

practices associated with clinical

management of ectopic pregnancy

changed in the late 1980s and early 1990s.

Before that time, treatment of ectopic

pregnancy usually required admission to a

hospital. Hospitalization statistics were

therefore useful for monitoring trends in

ectopic pregnancy. Beginning in 1989,

hospitalizations for ectopic pregnancy have

generally declined over time (Figure G).

Data suggest that nearly half of all ectopic

pregnancies are treated on an outpatient

basis.15

STD Surveillance 2005 Special Focus Profiles STDs in Women and Infants 49

1 Stamm WE, Guinan ME, Johnson C. Effect of

treatment regimens for Neisseria gonorrhoeae

on simultaneous infections with Chlamydia

trachomatis. N Engl J Med 1984;310:545-9.

2 Platt R, Rice PA, McCormack WM. Risk of

acquiring gonorrhea and prevalence of

abnormal adnexal findings among women

recently exposed to gonorrhea. JAMA

1983;250:3205-9.

3 Westrom L, Joesoef R, Reynolds G, et al. Pelvic

inflammatory disease and fertility: a cohort

study of 1,844 women with laparoscopically

verified disease and 657 control women with

normal laparoscopy. Sexually Transmitted

Diseases 1992;9:185-92.

4 Hook EW III, Handsfield HH. Gonococcal

infections in the adult. In: Holmes KK, Mardh

PA, Sparling PF, et al, eds. Sexually

Transmitted Diseases, 2nd edition. New York

City: McGraw-Hill, Inc, 1990:149-65.
50 STDs in Women and Infants Special Focus Profiles STD Surveillance 2005

5 Stamm WE, Holmes KK. Chlamydia trachomatis

infections in the adult. In: Holmes KK, Mardh

PA, Sparling PF, et al, eds. Sexually

Transmitted Diseases, 2nd edition. New York

City: McGraw-Hill, Inc, 1990:181-93.

6 Zimmerman HL, Potterat JJ, Dukes RL, et al.

Epidemiologic differences between chlamydia

and gonorrhea. Am J Public Health

1990;80:1338-42.

7 Hillis SD, Joesoef R, Marchbanks PA, et al.

Delayed care of pelvic inflammatory disease as

a risk factor for impaired fertility. Am J Obstet

Gynecol 1993;168:1503-9.

8 Scholes D, Stergachis A, Heidrich FE, Andrilla

H, Holmes KK, Stamm WE. Prevention of pelvic

inflammatory disease by screening for cervical

chlamydial infection. N Engl J Med

1996;34(21):1362-6.

9 Division of STD Prevention. Prevention of

Genital HPV Infection and Sequelae: Report of

an External Consultants’ Meeting. National

Center for HIV, STD, and TB Prevention,

Centers for Disease Control and Prevention,

Atlanta, December 1999.

10Handsfield HH, Stone KM, Wasserheit JN.

Prevention agenda for genital herpes. Sexually

Transmitted Diseases 1999;26:228-231.

11Centers for Disease Control. Guidelines for

prevention and control of congenital syphilis.

MMWR 1988;37(No.S-1).

12U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

13Centers for Disease Control and Prevention.

Congenital syphilis – United States, 2002.

MMWR 2004;53:716-9.

14Rolfs RT, Galaid EI, Zaidi AA. Pelvic

inflammatory disease: trends in hospitalization

and office visits, 1979 through 1988. Am J

Obstet Gynecol 1992;166:983-90.

15Centers for Disease Control and Prevention.

Ectopic pregnancy in the United States,

1990–1992. MMWR 1995;44:46-8.
STD Surveillance 2005 Special Focus Profiles STDs in Women and Infants 51

Rate per 100,000

population

Guam 819.6

Puerto Rico 166.4

Virgin Is. 332.4

<=300.0

300.1-500.0

>500.0

(n= 7)

(n= 24)

(n= 22)

VT 229.7

NH 203.9

MA 319.8

RI 428.3

CT 464.8

NJ 354.6

DE 585.6

MD 511.1

622.6

918.7

564.5 486.0

520.8 492.1

392.8

589.5

646.8

311.2

582.2 481.7

359.9

439.6 286.0

576.9

243.9

584.7

343.3

1116.6

563.2

382.3

420.2 467.9

654.8

457.5

591.9

343.4

566.7

594.9

342.6

424.4

729.0

496.3

545.8

519.7

259.0

443.6

433.2

244.8

530.2

347.6

Figure A. Chlamydia — Rates among women by state: United States and outlying areas, 2005

Note: The total chlamydia infection rate among women in the United States and outlying areas

(Guam, Puerto Rico and Virgin Islands) was 492.2 per 100,000 female population.

Rate per 100,000

population

Guam 87.2

Puerto Rico 9.6

Virgin Is. 31.7

<=19.0

19.1-100.0

>100.0

(n= 5)

(n= 25)

(n= 23)

VT 8.2

NH 14.7

MA 39.9

RI 40.6

CT 88.2

NJ 68.9

DE 121.0

MD 126.3

192.5

110.3

81.5 160.4

88.0 71.0

115.0

175.2

97.8

8.2

170.0 140.5

59.0

119.5 72.4

205.1

9.0

197.5

74.3

283.4

181.2

22.0

77.9 117.2

91.4

91.0

173.8

23.9

197.2

169.2

36.6

98.1

213.7

50.6

145.8

122.5

26.8

116.2

52.2

46.0

123.4

21.5

Figure B. Gonorrhea — Rates among women by state: United States and outlying areas, 2005

Note: The total gonorrhea infection rate among women in the United States and outlying areas

(Guam, Puerto Rico and Virgin Islands) was 117.5 per 100,000 female population.
52 STDs in Women and Infants Special Focus Profiles STD Surveillance 2005

Rate per 100,000

population

Guam 1.2

Puerto Rico 4.1

Virgin Is. 0.0

<=0.2

0.21-4.0

>4.0

(n= 22)

(n= 29)

(n= 2)

VT 0.0

NH 0.0

MA 0.1

RI 1.1

CT 0.1

NJ 0.4

DE 0.5

MD 3.1

3.0

0.3

1.7 1.5

0.7 0.1

1.1

1.1

0.0

0.9

0.7 0.3

0.1

0.1 0.1

4.8

0.0

0.4

0.1

0.8

0.4

0.2

0.0 2.1

1.7

0.3

1.3

0.0

0.7

1.0

0.1

0.5

0.8

0.0

2.1

2.2

0.1

0.5

0.2

0.0

0.1

0.0

Figure C. Primary and secondary syphilis — Rates among women by state: United States and

outlying areas, 2005

Note: The total rate of P&S syphilis among women in the United States and outlying areas (Guam,

Puerto Rico and Virgin Islands) was 0.9 per 100,000 female population.

Rate per 100,000

live births

Guam 30.5

Puerto Rico 21.7

Virgin Is. 0.0

<=1.0

1.1-10.0

>10.0

(n= 25)

(n= 16)

(n= 12)

VT 0.0

NH 0.0

MA 0.0

RI 0.0

CT 2.3

NJ 13.7

DE 0.0

MD 21.4

8.4

0.0

30.8 18.5

13.9 1.4

7.5

0.7

0.0

0.0

12.6 2.3

0.0

0.0 0.0

16.9

0.0

13.0

1.4

0.0

3.9

0.0

0.0 3.0

21.6

3.2

8.5

0.0

1.3

2.0

0.0

0.7

7.2

0.0

3.8

17.2

0.0

3.0

0.0

0.0

2.9

0.0

Figure D. Congenital syphilis — Rates for infants < 1 year of age by state: United States and

outlying areas, 2005

Note: The total rate of congenital syphilis for infants < 1 year of age for the United States and outlying

areas (Guam, Puerto Rico and Virgin Islands) was 8.2 per 100,000 live births. The Healthy

People 2010 target is 1.0 case per 100,000 live births.
STD Surveillance 2005 Special Focus Profiles STDs in Women and Infants 53

Positivity (%)

Puerto Rico 8.8

Virgin Is. 16.9

See*

<5.0

5.0-9.9

>=10.0

(n= 26)

(n= 5)

(n= 16)

(n= 6)

VT

NH

MA

RI

CT

NJ 6.3

DE

MD 3.8

DC

7.1

5.9

8.4 8.8

8.4

5.8 5.2

12.2

13.3

15.6

6.9

7.1 4.8

8.6

8.0

6.4

4.5

10.7

12.6

4.9

9.7

2.8 8.7

Figure E. Chlamydia — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2005

*States/areas not meeting minimum inclusion criteria in prenatal clinics.

Note: Includes states and outlying areas that reported chlamydia positivity data on at least 100

women aged 15-24 years during 2005.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

Positivity (%)

Puerto Rico 0.0

Virgin Is. 2.5

See*

<1.0

1.0-1.9

>=2.0

(n= 31)

(n= 11)

(n= 6)

(n= 5)

VT

NH

MA

RI

CT

NJ

DE

MD

DC

1.1

1.0

0.8 0.4

0.4

0.7 0.4

2.7

2.8

3.2

0.4

1.1 0.0

1.0

1.6

0.4 2.9

0.7

0.9

1.5

Figure F. Gonorrhea — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2005

*States/areas not meeting minimum inclusion criteria in prenatal clinics.

Note: Includes states and outlying areas that reported gonorrhea positivity data on at least 100

women aged 15-24 years during 2005.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention
54 STDs in Women and Infants Special Focus Profiles STD Surveillance 2005

Hospitalizations (in thousands)

0

10

20

30

40

50

1996 97 98 99 2000 01 02 03 04

Figure G. Ectopic pregnancy — Hospitalizations of women 15 to 44 years of age: United

States, 1996–2004

Note: The relative standard error for these estimates ranges from 10% to 14%. Data only

available through 2004.

SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC)

Hospitalizations (in thousands)

Acute, Unspec.

Chronic

0

15

30

45

60

75

1996 97 98 99 2000 01 02 03 04

Figure H. Pelvic inflammatory disease — Hospitalizations of women 15 to 44 years

of age: United States, 1996–2004

Note: The relative standard error for these estimates of the total number of acute unspecified PID

cases ranges from 8% to 11%. The relative standard error for these estimates of the total

number of chronic PID cases ranges from 11% to 18%. Data only available through 2004.

SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC)
STD Surveillance 2005 Special Focus Profiles STDs in Women and Infants 55

Visits (in thousands)

0

60

120

180

240

300

1996 97 98 99 2000 01 02 03 04 05

Figure I. Pelvic inflammatory disease — Initial visits to physicians’ offices by women

15 to 44 years of age: United States, 1996–2005

Note: The relative standard error for these estimates range from 19% to 30%. See Appendix

(Other Data Sources) and Table 42.

SOURCE: National Disease and Therapeutic Index (IMS Health)

STDs in Adolescents and Young

Adults

Public Health Impact

Compared to older adults, sexually active

adolescents (10- to 19-year-olds) and young

adults (20- to 24-year-olds) are at higher risk

for acquiring STDs for a combination of

behavioral, biological, and cultural reasons.

For some STDs, for example, Chlamydia

trachomatis, adolescent women may have a

physiologically increased susceptibility to

infection due to increased cervical ectopy.

The higher prevalence of STDs among

adolescents also reflects multiple barriers to

accessing quality STD prevention services,

including lack of insurance or other ability to

pay, lack of transportation, discomfort with

facilities and services designed for adults,

and concerns about confidentiality. Recent

estimates suggest that while representing

25% of the ever sexually active population,

15- to 24-year olds acquire nearly one-half

of all new STDs.1

Observations

Chlamydia

Numerous prevalence studies in various

clinic populations have shown that sexually

active adolescents have high rates of

chlamydia infection.2,3 The Regional

Infertility Prevention Projects (IPP) provide

routine screening for detecting chlamydia

infections among women attending family

planning clinics. IPP prevelance data

demonstrate that younger women

consistently have higher positivity than older

women, even when overall prevalence

declines.

After adjusting trends in chlamydia positivity

to account for changes in laboratory test

methods and associated increases in test

sensitivity (see Appendix), chlamydia test

positivity in 15- to 19-year-old women

decreased in 5 of 10 HHS regions between

2004 and 2005, increased in four regions,

and remained the same in one region

(Figure J).

Gonorrhea

As in previous years, 15- to 19-year-old

women had the highest rate of gonorrhea

(624.7 per 100,000 population) compared

to women in all other age categories

(Figure 18 and Table 19). Among men, 20-

to 24-year-olds had the highest rate of

gonorrhea (436.8 per 100,000 population,

Figure 18 and Table 19).

Gonorrhea rates among 15- to 19-year-old

women and 15- to 19-year-old men had

been decreasing in recent years, but in

2005 gonorrhea rates showed slight

increases in both groups (Figures 19 and

20, Table 19).

Similarly, gonorrhea rates among 20- to

24-year-old women and 20- to 24-year-old

men had been decreasing in recent years,

but in 2005 the gonorrhea rates in both

groups increased slightly (Figures 19 and

20, Table 19).

Primary and Secondary Syphilis

Syphilis rates in women are highest in the

20-24 year age group, 3.0 cases per

100,000 population in 2005. Rates among

STD Surveillance 2005 Special Focus Profiles STDs in Adolescents and Young Adults 57
15-19 year olds have decreased each year

from 2.5 cases per 100,000 population in

2001 to 1.5 in 2004, but increased to 1.9 in

2005 (Figure 34, Table 31).

In men, rates among 20- to 24-year-olds

increased each year from 4.8 cases per

100,000 population in 2001 to 8.1 in 2005

(Table 31). Rates among 15-19 year olds

had been low but increased to 2.4 in 2005

(Table 31).

National Job Training Program

Since 1990, approximately 20,000 female

National Job Training Program entrants

have been screened each year for

chlamydia. This program, administered by

the National Job Training Program at more

than 100 sites throughout the country, is a

job training program for economicallydisadvantaged youth aged 16-24 years-old.

Chlamydial infection is widespread

geographically and highly prevalent among

economically-disadvantaged young women

and men in the National Job Training

Program.4,5, 6 Specimens from at least 100

students from each state and outlying area

were tested by a national contract

laboratory. Among women entering the

program from 39 states, District of

Columbia, and Puerto Rico in 2005, based

on their place of residence before program

entry, the median state-specific chlamydia

prevalence was 9.2% (range 3.1% to

14.5%) (Figure K). Among men entering the

program from 48 states, the District of

Columbia, and Puerto Rico in 2005, the

median state-specific chlamydia prevalence

was 8.1% (range 0.0% to 14.8%) (Figure L).

Data from National Job Training Program

centers that submit gonorrhea specimens

from female students aged 16-24 years to

a national contract laboratory indicated a

high prevalence of gonococcal infection in

this population. Specimens from at least

100 students from each state and outlying

areas were tested by the contract

laboratory. Among women entering the

program from 32 states and District of

Columbia the median state-specific

gonorrhea prevalence was 2.4% (range

0.0% to 6.6%) in 2005 (Figure M).

Among men entering the program from

14 states in 2005, the median statespecific gonorrhea prevalence was 2.2%

(range 0.0% to 6.1%) (Figure N).

Juvenile Corrections Facilities

Among adolescent women attending

juvenile corrections facilities, data from the

Corrections STD Prevalence Monitoring

Project identified a median chlamydia

positivity of 14.2% (range 3.7% to 33.7%)

(Table AA) and a median gonorrhea

positivity of 4.7% (range 0.9% to 14.2%)

(Table CC). See Special Focus Profiles

(STDs in Persons Entering Corrections

Facilities).

58 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2005

1 Weinstock, H, Berman, S, Cates, W, Jr.

Sexually Transmitted Diseases among American

Youth: Incidence and Prevalence Estimates,

2000. Perspect Sex Reprod Health,

2004:36(1):6-10.

2 Centers for Disease Control and Prevention.

Recommendations for the prevention and

management of Chlamydia trachomatis

infections, 1993. MMWR 1993;42(No. RR-12).

4-6
STD Surveillance 2005 Special Focus Profiles STDs in Adolescents and Young Adults 59

3 Lossick J, DeLisle S, Fine D, Mosure DJ, Lee V,

Smith C. Regional program for widespread

screening for Chlamydia trachomatis in family

planning clinics. In: Bowie WR, Caldwell HD,

Jones RP, et al., eds. Chlamydial Infections:

Proceedings of the Seventh International

Symposium of Human Chlamydial Infections,

Cambridge, Cambridge University Press 1990,

pp. 575-9.

4 Mertz KJ, Ransom RL, St. Louis ME, Groseclose

SL, Hadgu A, Levine WC, Hayman C. Decline

in the prevalence of genital chlamydia infection

in young women entering a National Job

Training Program, 1990–1997. Am J Pub

Health 2001;91(8):1287-1290.

5 Joesoef MR, Mosure DJ. Prevalence of

chlamydia in young men in the United States

from newly implemented universal screening in

a National Job Training Program. Sexually

Transmitted Diseases 2006;33(10):636-639.

6 Joesoef MR, Mosure DJ. Prevalence of

chlamydia in young women entering the

National Job Training Program 1998–2004.

Sexually Transmitted Diseases

2006;33(9):571-575.
60 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2005

Region I

Region II

Region III

Region IV

Region V

Region VII Region VI

Region VIII

Region IX

Region X

7.3

01

6.5

02

5.9

03

5.7

04

6.3

05

12.4

01

11.7

02

12.9

03

12.5

04

10.0

05

8.7

01

8.3

02

8.3

03

9.1

04

8.9

05

12.3

01

12.2

02

11.8

03

13.0

04

13.1

05

9.2

01

9.4

02

9.9

03

10.1

04

10.5

05

13.9

01

14.4

02

13.9

03

14.1

04

14.3

05

7.2

01

7.5

02

7.3

03

7.9

04

7.9

05

8.0

01

8.4

02

7.8

03

7.8

04

7.7

05

10.3

01

9.0

02

9.5

03

10.0

04

9.4

05

7.1

01

7.6

02

8.7

03

9.0

04

8.5

05

IV

VII IX

I II

X

III

VI

V

VIII

Figure J. Chlamydia — Trends in positivity among 15- to 19-year-old women tested in family

planning clinics by HHS region, 2001–2005

Note: Trends adjusted for changes in laboratory test method and associated increases in test

sensitivity. See Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring) for

more information. See Appendix for definitions of Health and Human Services (HHS) regions.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

Prevalence (%)

Puerto Rico 10.3

Virgin Is.

See*

<10.0

10.0-14.9

>=15.0

(n= 12)

(n= 23)

(n= 18)

VT

NH

MA 7.8

RI 10.5

CT 5.6

NJ

DE 13.5

MD 10.0

DC 4.2

13.3

8.1 14.5

8.4

10.2

8.5

10.9

4.6

11.4 10.5

8.5 10.3

13.9

4.0

5.9

14.1

9.3

3.1

9.2

9.1

10.0

3.6

11.4

8.3

6.4

8.2

6.9

9.7

13.0

5.6

10.6

5.5

12.7

6.5

Figure K. Chlamydia — Prevalence among 16- to 24-year-old women entering the National Job

Training Program by state of residence: United States and outlying areas, 2005

*Fewer than 100 women residing in these states/areas and entering the National Job Training

Program were screened for chlamydia in 2005.

Note: The median state-specific chlamydia prevalence among female students entering the National

Job Training Program in 2005 was 9.2% (range 3.1% to 14.5%).
STD Surveillance 2005 Special Focus Profiles STDs in Adolescents and Young Adults 61

Prevalence (%)

Puerto Rico 6.0

Virgin Is.

See*

<10.0

10.0-14.9

>=15.0

(n= 3)

(n= 34)

(n= 16)

VT 1.0

NH

MA 3.2

RI 4.8

CT 10.9

NJ 8.2

DE 10.9

MD 10.5

DC 13.1

12.5

3.5

7.4 10.4

5.1 4.8

8.2

12.1

9.2

2.3

11.8 7.9

3.2

7.6 11.2

14.8

0.0

8.8

7.0

11.3

9.2

3.2

5.2 8.3

5.7

6.6

9.8

5.3

12.6

8.7

2.5

6.5

10.4

4.3

11.6

10.7

5.0

9.1

3.2

7.2

10.4

Figure L. Chlamydia — Prevalence among 16- to 24-year-old men entering the National Job

Training Program by state of residence: United States and outlying areas, 2005

*Fewer than 100 men residing in these states/areas and entering the National Job Training

Program were screened for chlamydia in 2005.

Note: The median state-specific chlamydia prevalence among male students entering the National

Job Training Program in 2005 was 8.1% (range 0.0% to 14.8%).

Prevalence (%)

Puerto Rico

Virgin Is.

See*

<2.0

2.0-4.9

>=5.0

(n= 20)

(n= 14)

(n= 16)

(n= 3)

VT

NH

MA 0.5

RI

CT 1.4

NJ

DE 2.4

MD

DC 3.8

6.6

1.3

1.2

2.9

3.3

0.0

3.3 5.6

3.0

4.4

2.7

4.2

5.1

2.2

0.0

2.5

1.2

2.8

0.7

1.5

2.6

1.0

1.9

0.5

4.7

3.2

1.9

0.0

2.0

Figure M. Gonorrhea — Prevalence among 16- to 24-year-old women entering the National

Job Training Program by state of residence: United States and outlying areas,

2005

*Fewer than 100 women residing in these states/areas and entering the National Job Training

Program were screened for gonorrhea by the national contract laboratory in 2005.
62 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2005

Prevalence (%)

Puerto Rico

Virgin Is.

See*

<2.0

2.0-4.9

>=5.0

(n= 39)

(n= 6)

(n= 7)

(n= 1)

VT

NH

MA

RI

CT

NJ

DE

MD 1.5 DC

0.7

2.0

3.0

2.6

6.1

2.7

1.8

1.1

3.4

3.0

0.0

0.0

2.5

Figure N. Gonorrhea — Prevalence among 16- to 24-year-old men entering the National Job

Training Program by state of residence: United States and outlying areas, 2005

*Fewer than 100 men residing in these states/areas and entering the National Job Training Program

were screened for gonorrhea by the national contract laboratory in 2005.
STDs in Racial and Ethnic

Minorities

Public Health Impact

Surveillance data show higher rates of

reported STDs among some minority racial

or ethnic groups when compared with rates

among whites. Race and ethnicity in the

United States are risk markers that correlate

with other more fundamental determinants

of health status such as poverty, access to

quality health care, health care seeking

behavior, illicit drug use, and living in

communities with high prevalence of STDs.

Acknowledging the disparity in STD rates by

race or ethnicity is one of the first steps in

empowering affected communities to

organize and focus on this problem.

Notifiable STDs

Surveillance data are based on cases of

STDs reported to state and local health

departments (see Appendix). In many

areas, reporting from public sources, (for

example, STD clinics) is more complete

than reporting from private sources. Since

minority populations may utilize public

clinics more than whites, differences in

rates between minorities and whites may

be increased by this reporting bias.

In 2005, 22.2% of reports on gonorrhea

cases were missing information on race

or ethnicity (ranging by state from 0.0%

to 50.7%), and 26.3% of reports on

chlamydia cases were missing race or

ethnicity (Table A1). To adjust for missing

data, cases in which information is

unknown are redistributed according to

the distribution of cases in which race or

ethnicity is known. This process may

exacerbate the reporting bias. Only 4.8%

of syphilis cases were missing race or

ethnicity.

Observations

Chlamydia

In 2005, 41.6% of all chlamydia cases

occurred among blacks, 28.8% occurred

among whites, and 18.1% occurred among

Hispanics (Table 10A). The rate of chlamydia

among black females in the United States

was more than seven times higher than the

rate among white females (1,729.0 and

237.2 per 100,000 population, respectively)

(Figure O, Table 10B). The chlamydia rate

among black males was more than 11

times higher than that among white males

(717.8 and 63.6 per 100,000 population,

respectively).

Gonorrhea

In 2005, approximately 68% of the total

number of cases of gonorrhea reported to

CDC occurred among African Americans

(Table 20A). In 2005, the rate of

gonorrhea among African Americans was

626.4 cases per 100,000 population,

among American Indian/Alaska Natives

the rate was 131.7, and among Hispanics

the rate was 74.8. These rates are 18, 4,

and 2 times higher, respectively, than the

rate among whites in 2005 of 35.2 cases

per 100,000 population. The rate of

gonorrhea among Asian/Pacific Islanders

in 2005 was 25.9 cases per 100,000

population (Figure 17, Table 20B).

STD Surveillance 2005 Special Focus Profiles STDs in Racial and Ethnic Minorities 63
All racial and ethnic groups saw slight

increases in gonorrhea rates from 2004 to

2005. Despite this slight increase in 2005,

between 2001 and 2005, the gonorrhea rate

among African Americans declined by

17.8% (762.0 and 626.4 cases per 100,000

population, respectively). During the same

five year period, gonorrhea rates increased

by 28.4% among American Indian/Alaska

Natives,19.7% among whites, 6.4% among

Hispanics, and 5.3% among Asian/Pacific

Islanders (Table 20B).

In 2005, gonorrhea rates among AfricanAmerican men were 24 times higher than

among white men; gonorrhea rates among

African-American women were 14 times

higher than among white women (Figure P).

In 2005, gonorrhea rates were highest for

African Americans aged 15 to 19 and 20 to

24 years among all racial, ethnic, and age

categories. African-American women aged

15-19 years had a gonorrhea rate of

2,814.0 cases per 100,000 females. This

rate was 14 times greater than the 2005 rate

among white females of similar age (204.7).

African-American men in the 15- to

19-year-old age category had a 2005

gonorrhea rate of 1,417.5 cases per

100,000 males, which was 36 times higher

than the rate among 15- to 19-year-old

white males of 39.7 per 100,000. Among

20- to 24-year-olds, the gonorrhea rate

among African Americans was 15 times

greater than that among whites (2,452.9

and 161.0 cases per 100,000 population,

respectively) (Table 20B).

From 2001 to 2004, gonorrhea rates among

15- to 19-year-old African-American females

and males decreased 21.0% and 22.4%,

respectively. However, both groups saw

slight increases from 2004 to 2005 (3.3%

and 4.2%), the first increases for these

groups in recent years (Figures Q and R).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s

occurred primarily among heterosexual,

minority populations.1 During the 1990s,

the rate of primary and secondary (P&S)

syphilis declined among all racial and

ethnic groups (Figure 32). From 2001 to

2005, the overall rate of P&S syphilis and

rates among non-Hispanic whites,

Hispanics, and Asian/Pacific Islanders

increased; the rates among American

Indian/Alaska Natives fluctuated; and the

rates among African Americans decreased

between 2001 and 2003, but then

increased between 2004 and 2005.

Between 2004 and 2005, the rates of

primary and secondary syphilis increased

11.4% among African Americans; 12.9%

among African-American men and 4.8%

among African-American women (Table

32B). Between 2004 and 2005, P&S

syphilis rates for African Americans in most

age groups increased. (Table 32B).

Between 2004 and 2005, the rates of

primary and secondary syphilis increased

6.5% among Hispanics; from 5.4 to 5.5

among Hispanic men and from 0.7 to 0.9

among Hispanic women (Table 32B).

Between 2003 and 2004, P&S syphilis

rates for Hispanics in most age groups

increased. (Table 32B).

In 2005, 41% of all cases of P&S syphilis

reported to CDC occurred among African

Americans and 40% of all cases occurred

among non-Hispanic whites (Table 32A).

Compared to non-Hispanic whites, the

2005 rate for African Americans was 5.4

times higher, and for Hispanics, 1.8 times

higher (Table 32B).

In 2005, the rate of P&S syphilis among

African Americans was highest among

women aged 20-24 years (13.5) and

among men aged 25-29 (38.2) (Table

32B). For Hispanics, the rate was highest

among women aged 20-24 years (2.9)

and among men aged 35-39 years (14.0)

(Table 32B).

64 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2005
Congenital Syphilis

In 2005, the rate of congenital syphilis

(based on the mother’s race/ethnicity) was

25.9 cases per 100,000 live births among

African Americans and 13.4 cases per

100,000 live births among Hispanics.

These rates are 19.9 and 10.3 times

higher, respectively, than the 2005 rate

among non-Hispanic whites (1.3 cases per

100,000 live births) (Figure V, Table 40).

STD Surveillance 2005 Special Focus Profiles STDs in Racial and Ethnic Minorities 65

1 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P,

Greenspan JR. Epidemiology of syphilis in the

United States, 1941 through 1993. Sexually

Transmitted Diseases 1996;23:16-23.
66 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2005

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

63.6

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

237.2

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

717.8

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

1729.0

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

201.4

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

733.2

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

79.3

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

222.3

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

305.9

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

1177.7

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

163.5 Total

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total 497.9

Figure O. Chlamydia — Rates by race/ethnicity and sex: United States, 2005

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

27.7

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

42.5

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

666.0

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

590.4

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

67.5

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

82.7

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

26.6

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

25.3

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

92.2

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

170.0

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

112.0 Total

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total 119.5

Figure P. Gonorrhea — Rates by race/ethnicity and sex: United States, 2005
STD Surveillance 2005 Special Focus Profiles STDs in Racial and Ethnic Minorities 67

Rate (per 100,000 population)

White

Black

Hispanic

Asian/PI

AI/AN

0

800

1,600

2,400

3,200

4,000

1996 97 98 99 2000 01 02 03 04 05

Figure Q. Gonorrhea — Rates among 15- to 19-year-old females by race/ethnicity:

United States, 1996–2005

Rate (per 100,000 population)

White

Black

Hispanic

Asian/PI

AI/AN

0

500

1,000

1,500

2,000

2,500

1996 97 98 99 2000 01 02 03 04 05

Figure R. Gonorrhea — Rates among 15- to 19-year-old males by race/ethnicity:

United States, 1996–2005
68 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2005

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

3.3

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

0.3

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

15.7

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

4.4

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

5.5

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

0.9

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

2.3

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

0.2

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

3.3

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total

1.6

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

5.1 Total

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

White

Black

Hispanic

Asian/PI

AI/AN

Total 0.9

Figure S. Primary and secondary syphilis — Rates by race/ethnicity and sex: United

States, 2005

Rate (per 100,000 population)

White

Black

Hispanic

Asian/PI

AI/AN

0

10

20

30

40

50

1996 97 98 99 2000 01 02 03 04 05

Figure T. Primary and secondary syphilis — Rates among 15- to 19-year-old females by

race/ethnicity: United States, 1996–2005
STD Surveillance 2005 Special Focus Profiles STDs in Racial and Ethnic Minorities 69

Rate (per 100,000 population)

White

Black

Hispanic

Asian/PI

AI/AN

0

5

10

15

20

25

1996 97 98 99 2000 01 02 03 04 05

Figure U. Primary and secondary syphilis — Rates among 15- to 19-year-old males by

race/ethnicity: United States, 1996–2005

Rate (per 100,000 live births)

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

0

30

60

90

120

150

1996 97 98 99 2000 01 02 03 04 05

Figure V. Congenital syphilis — Rates among infants < 1 year of age by mother’s

race/ethnicity: United States, 1996–2005

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births.

Less than 5% of cases had missing maternal race/ethnicity information and were excluded.

STDs in Men Who Have Sex with

Men

Public Health Impact

Data from several U.S. cities and projects,

including syphilis outbreak investigations

and the Gonococcal Isolate Surveillance

Project (GISP) suggest that an increasing

number of men who have sex with men

(MSM) are acquiring STDs.1, 2, 3, 4, 5, 6, 7 Data also

suggest that an increasing number of MSM

are engaging in sexual behaviors that place

them at risk for STDs and HIV infection.8

Several factors may be contributing to this

change, including the availability of highly

active antiretroviral therapy (HAART) for

HIV infection.9 Because STDs and the

behaviors associated with acquiring them

increase the likelihood of acquiring and

transmitting HIV infection,10 the rise in STDs

among MSM may be associated with an

increase in HIV incidence among MSM.11

Observations

Most nationally notifiable STD surveillance

data reported to CDC do not include

information regarding sexual behaviors;

therefore, national trends in STDs among

MSM in the United States are not currently

available. Data from enhanced surveillance

projects are presented in this section to

provide information regarding STDs in

MSM.

Monitoring Trends in Prevalence of

STDs and HIV Risk Behaviors

among Men Who Have Sex with

Men (MSM Prevalence Monitoring

Project), STD Clinics, 1999–2005

From 1999 through 2005, nine U.S. cities

participating in the MSM Prevalence

Monitoring Project submitted syphilis,

gonorrhea, chlamydia, and HIV test data to

CDC from 107,370 MSM visits to STD

clinics; data from 89,998 MSM visits were

submitted from six public STD clinics

(Denver, Long Beach, New York City,

Philadelphia, San Francisco, and Seattle)

and data from 17,372 MSM visits were

submitted from three STD clinics in

community-based, gay men’s health clinics

(Chicago, the District of Columbia, and

Houston). In 2005, eight U.S. cities

submitted information from 18,455 MSM

STD clinic visits.

The MSM Prevalence Monitoring Project

includes data from culture and non-culture

tests collected during routine care and

reflects testing practices at participating

clinics. City-specific medians and ranges

were calculated for the proportion of tests

done and STD and HIV test positivity.

Gonorrhea

From 1999 to 2005 the number of

gonorrhea tests for all anatomic sites

combined has increased in all eight

cities. The trend in the number of

positive gonorrhea tests for all anatomic

sites has varied by city. For all cities, the

number of symptomatic positive

STD Surveillance 2005 Special Focus Profiles STDs in Men Who Have Sex with Men 71

1-7
gonorrhea tests accounts for the majority

of the overall positive tests (Figure W).

In 2005, 78% (range: 57-95%) of MSM

were tested for urethral gonorrhea, 26%

(range: 3-69%) were tested for rectal

gonorrhea, and 26% (range: 4-87%) were

tested for pharyngeal gonorrhea.

In 2005, median clinic urethral gonorrhea

positivity in MSM was 11% (range:

8-14%), median rectal gonorrhea

positivity was 8% (range: 4-10%), and

median pharyngeal gonorrhea positivity

was 7% (range: 1-21%).

Syphilis

In 2005, 79% (range: 60-92%) of MSM

visiting participating STD clinics had a

nontreponemal serologic test for syphilis

(STS) [RPR or VDRL] performed compared

with 69% (range: 54-93%) in 1999.

Overall, median syphilis seroreactivity

among MSM tested increased from 4%

(range: 4-13%) in 1999 to 11% (range:

5-13%) in 2005 (Figure X).

Chlamydia

In 2005, a median of 78% (range: 58-94%)

of MSM visiting participating STD clinics

were tested for urethral chlamydia; median

urethral chlamydia positivity was 6%

(range: 5-8%).

HIV Infection

In 2005, a median of 68% (range: 31-82%)

of MSM visiting STD clinics in the project

and not previously known to be

HIV-positive were tested for HIV; median

HIV positivity was 4% (range: 3-7%). HIV

positivity varied by race/ethnicity, but was

higher in African-American and Hispanic

MSM. HIV positivity was 3% (range: 2-4%)

in whites, 7% (range 3-12%) in African

Americans, and 7% (range: 3-10%) in

Hispanics (Figure Y).

In 2005, median HIV prevalence among

MSM, including persons previously known

to be HIV-positive and persons testing

HIV-positive at their current visit, was 12%

(range 9-15%). HIV prevalence was 10%

(range: 7-13%) in whites, 20% (range:

15-27%) in African Americans, and 15%

(range: 7-20%) in Hispanics.

STDs by Race/Ethnicity

In 2005, by race/ethnicity, urethral

gonorrhea positivity was 11% (range:

7-13%) in whites, 15% (range: 9-23) in

African Americans, and 9% (range: 6-15%)

in Hispanics. Rectal gonorrhea positivity

was 8% (range: 4-11%) in whites, 4%

(range: 2-7%) in African Americans, and

8% (range: 4-11%) in Hispanics.

Pharyngeal gonorrhea positivity was 5%

(range: 1-12%) in whites, 8% (range: 1-9%)

in African Americans, and 4% (range:

1-10%) in Hispanics (Figure Y).

Median syphilis seroreactivity was 9%

(range: 3-12%) in whites; 14% (range:

9-32%) in African Americans, and 14%

(range: 4-19%) in Hispanics (Figure Y).

Urethral chlamydia was 6% (range: 4-8%)

in whites; 7% (range: 3-15%) in African

Americans, and 6% (range: 3-8%) in

Hispanics (Figure Y).

STDs by HIV Status, STD Clinics,

2005

In 2005, by HIV status, urethral gonorrhea

positivity was 18% (range:15-27) in

HIV-positive MSM and 9% (range 7-14%)

in MSM who were HIV-negative or of

unknown HIV status; rectal gonorrhea

positivity was 10% (range: 6-19%) in

HIV-positive MSM and 7% (range: 3-9%)

in MSM who were HIV-negative or of

unknown HIV status; pharyngeal

gonorrhea positivity was 6% (range:

1-11%) in HIV-positive MSM and 6%

(range: 1-20%) in MSM who were

72 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2005
HIV-negative or of unknown HIV status

(Figure Z).

Median syphilis seroreactivity was 23%

(range: 18-43%) in HIV-positive MSM and

8% (range: 3-12%) in MSM who were

HIV-negative or of unknown HIV status

(Figure Z).

Median urethral chlamydia positivity was

7% (range: 5-10%) in HIV-positive MSM

and 6% (range: 5-8%) in MSM who were

HIV-negative or of unknown HIV status

(Figure AA).

Nationally Notifiable Syphilis

Surveillance Data

Primary and secondary (P&S) syphilis

increased in the United States between 2001

and 2005, with a 78.6% increase in the

number of P&S syphilis cases among men

and a 31.9% decrease in the number of

cases among women (Tables 25 and 26). In

2005, the rate of reported P&S syphilis

among men (5.1 cases per 100,000 males)

was 5.7 times greater than the rate among

women (0.9 cases per 100,000 females)

(Figure S, Table 23). Trends in the syphilis

male-to-female rate ratio, which are

assumed to reflect, in part, syphilis trends

among MSM,7 have been increasing in the

United States during recent years (Figure 33).

The overall male-to-female syphilis rate ratio

has risen steadily from 2.1 in 2001 to 5.7 in

2005 (Figure 33, Tables 25 and 26). The

increase in the male-to-female rate ratio

occurred among all racial and ethnic groups

between 2001 and 2005. Additional

information on syphilis can be found in the

Syphilis section (National Profile).

Gonococcal Isolate Surveillance

Project (GISP)

The Gonococcal Isolate Surveillance

Project (GISP), a collaborative project

among selected STD clinics, was

established in 1986 to monitor trends in

antimicrobial susceptibilities of strains of

Neisseria gonorrhoeae in the United

States.12

GISP also reports the percentage of N.

gonorrhoeae isolates obtained from MSM.

Overall, the proportion of isolates from

MSM in GISP clinics has been increasing

steadily from 4% in 1988 to 20.2% in

2004 and now 21.9% in 2005, with most

of the increase occurring after 1993

(Figure AA). Additional information on

GISP may be found in the Gonorrhea

section (National Profile).

The proportion of isolates coming from

MSM varies geographically with the

largest percentage from the West Coast

(Figure BB).

Due to increases in the proportion of N.

gonorrhoeae isolates from MSM that are

quinolone-resistant (Figure 25), in 2006

CDC recommended that quinolones no

longer be used to treat gonorrhea among

MSM.13,14

STD Surveillance 2005 Special Focus Profiles STDs in Men Who Have Sex with Men 73

1 Centers for Disease Control and Prevention.

Gonorrhea among men who have sex with men

– selected sexually transmitted disease clinics,

1993–1996. MMWR 1997;46:889-92.

2 Centers for Disease Control and Prevention.

Resurgent bacterial sexually transmitted disease

among men who have sex with men – King

County, Washington, 1997–1999. MMWR

1999;48:773-7.
74 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2005

3 Centers for Disease Control and Prevention.

Outbreak of syphilis among men who have sex

with men – Southern California, 2000. MMWR

2001;50:117-20.

4 Fox KK, del Rio C, Holmes K, et. al. Gonorrhea

in the HIV era: A reversal in trends among men

who have sex with men. Am J Public Health

2001;91:959-964.

5 Centers for Disease Control and Prevention.

Primary and secondary syphilis among men

who have sex with men – New York City, 2001.

MMWR 2002;51:853-6.

6 Centers for Disease Control and Prevention.

Primary and secondary syphilis – United States,

2003–2004. MMWR 2006;55:269-73.

7 Beltrami JF, Shouse RL, Blake PA. Trends in

infectious diseases and the male to female ratio:

possible clues to changes in behavior among

men who have sex with men. AIDS Educ Prev

2005;17:S49-S59.

8 Stall R, Hays R, Waldo C, Ekstrand M,

McFarland W. The gay ‘90s: a review of

research in the 1990s on sexual behavior and

HIV risk among men who have sex with men.

AIDS 2000;14:S1-S14.

9 Scheer S, Chu PL, Klausner JD, Katz MH,

Schwarcz SK. Effect of highly active

antiretroviral therapy on diagnoses of sexually

transmitted diseases in people with AIDS.

Lancet 2001;357:432-5.

10Fleming DT, Wasserheit JN. From

epidemiologic synergy to public health policy

and practice: the contribution of other sexually

transmitted diseases to sexual transmission of

HIV infection. Sex Transm Infect 1999;75:3-17.

11Centers for Disease Control and Prevention.

HIV/AIDS Surveillance Report, 2003, (Vol. 15).

Atlanta: U.S. Department of Health and Human

Services, Centers for Disease Control and

Prevention; 2004.

12Centers for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance 2005

Supplement: Gonococcal Isolate Surveillance

Project (GISP) Annual Report 2005. Atlanta,

GA: U.S. Department of Health and Human

Services (available first quarter 2007).

13Centers for Disease Control and Prevention.

Increases in fluoroquinolone-resistant Neisseria

gonorrhoeae among men who have sex with

men – United States, 2003, and revised

recommendations for gonorrhea treatment,

2004. MMWR 2004;53:335-338.

14Centers for Disease Control and Prevention.

Sexually Transmitted Diseases Treatment

Guidelines, 2006. MMWR, 2006;55(No.

RR-11).
STD Surveillance 2005 Special Focus Profiles STDs in Men Who Have Sex with Men 75

Total GC tests Positives

CHICAGO

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005

0

50

100

150

200

Total GC tests Positives

HOUSTON

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005

0

50

100

150

200

Total GC tests Positives

PHILADELPHIA

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005

0

50

100

150

200

Total GC tests Positives

SAN FRANCISCO

0

2000

4000

6000

8000

1999 2000 2001 2002 2003 2004 2005

0

300

600

900

1200

Total GC tests Positives

DISTRICT OF COLUMBIA

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005

0

125

250

375

500

Total GC tests Positives

NEW YORK CITY

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005

0

125

250

375

500

Total GC tests Positives

DENVER

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005

0

125

250

375

500

Total GC tests Positives

SEATTLE

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005

0

125

250

375

500

Positive GC tests

Positive GC tests in symptomatic men

Figure W. MSM Prevalence Monitoring Project — Number of gonorrhea tests and number

of positive tests in men who have sex with men, STD clinics, 1999–2005

Note: The bars represent the number of GC tests at all anatomic sites (pharyngeal, rectal, and

urethral) each year. The scales on the left and right axis differ. The bar graphs use the

scale on the left. The line graphs use the scale on the right.
76 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2005

7.4

2000

15.8

2001

10.4

2002

14.0

2003

3.7

1999

3.2

2000

7.1

2001

8.9

2002

10.4

2003

10.8

2004

8.8

2005

4.3

1999

3.9

2000

3.3

2001

3.4

2002

5.5

2003

7.0

2004

9.4

2005

1.5

2000

1.5

2001

3.7

2002

4.7

2003

5.7

2004

4.7

2005

6.7

2001

10.3

2002

16.6

2003

14.0

2004

12.8

2005

3.5

2000

4.3

2001

7.0

2002

8.5

2003

9.7

2004

13.3

2005

3.4

2000

5.0

2001

5.9

2002

7.6

2003

10.5

2004

6.3

2005

13.1

1999

6.9

2000

8.7

2001

12.1

2002

13.4

2003

13.0

2004

13.3

2005

10.3

2002

10.2

2003

10.6

2004

12.5

2005

Seattle, WA

San Francisco, CA

Long Beach, CA*

Denver, CO Houston, TX Chicago, IL

District of Columbia

Philadelphia, PA

New York City, NY

Figure X. MSM Prevalence Monitoring Project — Syphilis serologic reactivity among men

who have sex with men, STD clinics, 1999–2005

*Data not reported in 2004 or 2005.

Median positivity

White

Black

Hispanic

0

5

10

15

20

25

Urethral

gonorrhea

Rectal

gonorrhea

Pharyngeal

gonorrhea

Urethral

chlamydia

HIV* yphilis† S

Figure Y. MSM Prevalence Monitoring Project — Test positivity for gonorrhea, chlamydia,

and HIV and seroreactivity to syphilis among men who have sex with men, by

race/ethnicity, STD clinics, 2005

*Excludes persons previously known to be HIV-positive.

†

Seroreactivity.
STD Surveillance 2005 Special Focus Profiles STDs in Men Who Have Sex with Men 77

Median positivity

HIV-positive

HIV-negative or unknown

0

5

10

15

20

25

Urethral

gonorrhea

Rectal

gonorrhea

Pharyngeal

gonorrhea

Urethral

chlamydia

Syphilis*

Figure Z. MSM Prevalence Monitoring Project — Test positivity for gonorrhea and

chlamydia and syphilis seroreactivity among men who have sex with men, by

HIV status, STD clinics, 2005

*Seroreactivity.

Percent

0

5

10

15

20

25

1988 90 92 94 96 98 2000 02 04

Figure AA. Gonococcal Isolate Surveillance Project (GISP) — Percent of urethral

Neisseria gonorrhoeae isolates obtained from men who have sex with men

attending STD clinics, 1988–2005
78 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2005

0%

50%

100%

'02 '03 '04 '05

% of Isolates

from MSM

BHM PHX

LBC

LAX

ORA

SDG

SFO DEN

MIA

ATL

HON

TRP

CHI

NOR

BAL

DTR

MIN

LVG

ALB

GRB

CIN

CLE

OKC

POR

PHI

DAL

SEA

Figure BB. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates obtained from men who have sex with men attending

STD clinics, 2002–2005

Note: Not all clinics participated in GISP for the last 4 years. Clinics include: ALB=Albuquerque, NM;

ATL=Atlanta, GA; BAL=Baltimore, MD; BHM=Birmingham, AL; CHI=Chicago, IL; CIN=Cincinnati, OH;

CLE=Cleveland, OH; DAL=Dallas, TX; DEN=Denver, CO; DTR=Detroit, MI; HON=Honolulu, HI; LAX=Los

Angeles, CA; LBC=Long Beach, CA; LVG=Las Vegas, NV; MIA=Miami, FL; MIN=Minneapolis, MN;

GRB=Greensboro, NC; NOR=New Orleans, LA; OKC=Oklahoma City, OK; ORA=Orange County, CA;

PHI=Philadelphia, PA; PHX=Phoenix, AZ; POR=Portland, OR; SDG=San Diego, CA; SEA=Seattle, WA;

SFO=San Francisco, CA; and TRP=Tripler Army Medical Center, HI (does not provide sexual risk

behavior data).
STDs in Persons Entering

Corrections Facilities

Public Health Impact

Multiple studies and surveillance projects

have demonstrated a high prevalence of

STDs in persons entering jails and juvenile

corrections facilities.1,2,3,4 Screening for

chlamydia, gonorrhea, and syphilis at intake

offers an opportunity to identify infections,

prevent complications, and reduce

transmission in the general community. For

example, data from one study in a locale

with high syphilis incidence suggested that

screening and treatment of women inmates

for syphilis may result in reduction of

syphilis in the general community.5 In some

locations, a substantial proportion of all

early syphilis cases are reported from

corrections facilities.4 Reduction of

chlamydia and gonorrhea in the community

may also result from chlamydia and

gonorrhea screening and treatment in jails.6

Collecting positivity data and analyzing

trends in STD prevalence in the inmate

population can provide a tool for

monitoring trends in STD prevalence in the

general community.3-4

Description of Population

In 2005, STD screening data from

corrections facilities were reported from 32

states for chlamydia, 29 states for

gonorrhea, and 13 states for syphilis. These

data were reported in response to CDC’s

request for data, as part of the Corrections

STD Prevalence Monitoring Project and/or

the Regional Infertility Prevention Project

(IPP). IPP provided CDC with line-listed

data for chlamydia, gonorrhea, and syphilis

(syphilis line-listed data only from San

Francisco and Los Angeles).

The tables and figures shown in this

section represent 58,977 chlamydia tests in

women and 141,132 in men; 49,675

gonorrhea tests in women and 120,676 in

men; and 69,661 syphilis serologic tests in

women and in 226,619 men entering

corrections facilities during 2005.

Chlamydia

In adolescent women entering 57 juvenile

corrections facilities, the median chlamydia

positivity by facility was 14.2% (range

3.7% to 33.7%); positivity was uniformly

high (greater than 10%) in all facilities

reporting data (Table AA). Positivity in

women was also uniformly higher than in

men. In adolescent men entering 87

juvenile corrections facilities, the median

chlamydia positivity was 6.0% (range

0.0% to 44.8%).

In women 12 to 19 years of age entering

juvenile corrections facilities, the overall

chlamydia positivity was 16.3% (Figure

CC). Positivity was high (greater than

10%) for all ages and uniformly higher in

women than in men. Positivity in women

increased from 12.8% for those aged 12

years to 17.2% for those aged 16 years

and, then, declined to 16.1% for those

aged 19 years. In men 12 to 19 years of

age entering juvenile corrections facilities,

the overall chlamydia positivity was 6.6%.

Chlamydia positivity increased from 1.7%

for those aged 12 years to 11.5% for those

aged 19 years.

STD Surveillance 2005 Special Focus Profiles STDs in Persons Entering Corrections Facilities 79

1-4
In women entering 38 adult corrections

facilities, the median positivity for chlamydia

by facility was 7.4% (range 1.7% to 21.4%)

(Table BB). In men entering 41 adult

corrections facilities, the median chlamydia

positivity was 8.1% (range 2.3% to 20.8%).

In women entering adult corrections facilities,

the overall chlamydia positivity was 8.9%

(Figure DD). Chlamydia positivity decreased

with age from 19.1% for those aged < 20

years to 3.9% for those aged > 34 years.

Similar trends were also observed in adult

men. Positivity was higher in women than in

men for all age groups. Positivity in young

adult women (< 25 years) was similar to

positivity in adolescent women, but positivity

in young adult men (< 25 years) was higher

than in adolescent men. Although overall

chlamydia positivity in women entering

adult correction facilities was significantly

lower than in women entering juvenile

corrections facilities, chlamydia positivity in

women aged < 20 years attending adult

corrections facilities was higher than in

women attending juvenile corrections

facilities.

Gonorrhea

The median positivity by facility for

gonorrhea in women entering 38 juvenile

corrections facilities was 4.7% (range 0.9%

to 14.2%). Positivity in women was

uniformly higher than in men. The median

positivity for gonorrhea in men entering 65

juvenile corrections facilities was 1.0%

(range 0.0% to 19.0%) (Table CC).

In women 12 to 19 years of age entering

juvenile corrections facilities, the overall

gonorrhea positivity was 5.9% (Figure EE).

Gonorrhea positivity increased with age

from 2.2% for those aged 12 years to 6.5%

for those aged 16 years, and then, declined

to 4.8% for those aged 19 years. Positivity in

women was higher than in men for all ages.

In women entering 33 adult facilities, the

median positivity by facility was 2.8%

(range 0.0% to 13.8%) (Table DD). In men

entering 35 adult corrections facilities, the

median gonorrhea positivity was 2.3%

(range 0.0% to 11.8%).

In women entering adult corrections

facilities, the overall gonorrhea positivity

was 3.9%. Gonorrhea positivity decreased

with age from 7.3% for those aged < 20

years to 2.2% for those aged > 34 years

(Figure FF). A similar trend was also

observed in adult men. Positivity in

women was higher than in men for all age

groups. Women aged < 20 years

attending adult facilities had higher

gonorrhea positivity than women attending

juvenile detention facilities. This was also

true for men.

Syphilis

The median syphilis serologic positivity

(RPR quantitative test) by facility was 1.3%

(range 0.0% to 14.6%) in adolescent

women entering nine juvenile corrections

facilities and 0.6% (range 0.0% to 6.9%)

in adolescent men entering 8 juvenile

corrections facilities (Table EE).

In women entering 23 adult corrections

facilities the median serologic positivity was

5.2% (range 1.2% to 12.6%) (Table FF).

In men at 32 adult corrections facilities, the

median syphilis serologic positivity was

3.7% (range 0.4% to 9.5%)

80 STDs in Persons Entering Corrections Facilities Special Focus Profiles STDSurveillance 2005
STD Surveillance 2005 Special Focus Profiles STDs in Persons Entering Corrections Facilities 81

1 Heimberger TS. Chang HG. Birkhead GS.

DiFerdinando GD. Greenberg AJ. Gunn R.

Morse DL. High prevalence of syphilis detected

through a jail screening program. A potential

public health measure to address the syphilis

epidemic. Arch Intern Med

1993;153:1799-1804.

2 Centers for Disease Control and Prevention.

Syphilis screening among women arrestees at

the Cook County Jail – Chicago, 1996. MMWR

1998;47:432-3.

3 Mertz KJ, Schwebke JR, Gaydos CA, Beideinger

HA, Tulloch SD, Levine WC. Screening women

in jails for chlamydial and gonococcal infection

using urine tests: Feasibility, acceptability,

prevalence and treatment rates. Sexually

Transmitted Diseases 2002;29:271-276.

4 Kahn R, Voigt R, Swint E, Weinstock H. Early

syphilis in the United States identified in

corrections facilities, 1999–2002. Sexually

Transmitted Diseases 2004;31:360-364.

5 Blank S, McDonnell DD, Rubin SR et al. New

approaches to syphilis control. Finding

opportunities for syphilis treatment and

congenital syphilis prevention in a women’s

correctional setting. Sexually Transmitted

Diseases 1997; 24:218-26.

6 Barry P, Kent CK, Scott KC, Goldenson J,

Klausner JD. Sexually transmitted infection

screening in county jails is associated with a

decrease in community prevalence of gonorrhea

and chlamydia – San Francisco, 1997–2004

[Abstract no. D1f]. In: Program and abstracts of

the 2006 National STD Prevention Conference,

Jacksonville, Florida, May 8-11, 2006.
82 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2005

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

1.7

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

1.8

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

3.1

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

5.3

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

7.5

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

8.0

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

8.8

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

11.5

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

12.8

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

13.6

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

15.4

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

16.8

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

17.2

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

16.3

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

15.8

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

16.1

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

6.6 Total

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total 16.3

Figure CC. Chlamydia — Positivity by age, juvenile corrections facilities, 2005

Note: Percent positivity is presented from facilities reporting > 100 test results.

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

13.3

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

11.6

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

7.1

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

5.0

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

2.6

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

19.1

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

14.0

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

10.2

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

6.3

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

3.9

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

8.0 Total

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total 8.9

Figure DD. Chlamydia — Positivity by age, adult corrections facilities, 2005

Note: Percent positivity is presented from facilities reporting > 100 test results.
STD Surveillance 2005 Special Focus Profiles STDs in Persons Entering Corrections Facilities 83

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

0.5

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

0.2

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

0.6

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

1.1

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

1.5

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

1.6

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

1.9

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

2.3

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

2.2

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

4.4

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

5.5

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

5.9

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

6.5

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

5.9

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

5.5

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total

4.8

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

1.3 Total

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

12

13

14

15

16

17

18

19

Total 5.9

Figure EE. Gonorrhea — Positivity by age, juvenile corrections facilities, 2005

Note: Percent positivity is presented from facilities reporting > 100 test results.

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

3.8

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

2.7

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

1.7

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

1.1

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

0.9

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

7.3

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

5.3

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

4.6

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

3.4

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total

2.2

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

2.0 Total

Men Positivity Women

22.0 17.6 13.2 8.8 4.4 0 0 4.4 8.8 13.2 17.6 22.0 Age

<20

20-24

25-29

30-34

>=35

Total 3.9

Figure FF. Gonorrhea — Positivity by age, adult corrections facilities, 2005

Note: Percent positivity is presented from facilities reporting > 100 test results.
84 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2005

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 3 4,570 7.2 (5.6-7.6) 3 1,629 20.5 (14.7-21.1)

California* 21 29,033 5.1 (2.0-44.8) 22 12,395 13.0 (3.7-22.8)

Colorado 2 275 10.1 (6.9-13.2) 0 – –

Connecticut 1 505 1.6 2 239 10.9 (10.6-11.1)

Delaware 1 962 5.8 1 254 13.4

Georgia 1 1,183 11.4 1 773 25.0

Hawaii 1 138 4.3 1 114 18.4

Illinois 3 5,160 9.4 (6.2-10.3) 1 561 23.0

Indiana 1 1,464 7.1 1 482 16.4

Kentucky 7 1,752 5.5 (2.4-8.9) 1 187 11.2

Massachusetts 7 3,458 5.0 (2.1-7.0) 2 769 12.0 (4.8-19.2)

Michigan 3 845 8.1 (6.0-8.4) 2 365 17.3 (14.0-20.6)

Mississippi 1 399 12.5 2 390 21.3 (18.5-24.0)

Missouri 1 463 8.9 1 115 16.5

Nebraska 1 959 5.9 1 317 12.3

Nevada 2 964 8.4 (4.7-12.1) 2 307 25.4 (17.1-33.7)

New Jersey 3 2,592 8.2 (7.5-10.6) 1 214 29.0

New Mexico 1 414 11.1 0 – –

New York 5 3,675 3.6 (0.0-7.1) 2 802 13.9 (13.0-14.9)

North Dakota 1 102 7.8 0 – –

Ohio 1 972 12.2 2 366 16.8 (9.4-24.2)

Oregon 3 1,542 5.5 (3.2-6.9) 2 403 9.0 (6.7-11.3)

Pennsylvania 4 3,152 10.1 (3.6-15.9) 1 388 20.6

Texas 3 6,750 7.4 (0.5-8.3) 2 1,726 24.5 (22.5-26.5)

Utah 2 721 5.1 (4.6-5.7) 2 387 14.2 (14.1-14.3)

Virginia 1 809 9.1 0 – –

Washington 4 964 5.9 (3.4-8.3) 2 255 17.2 (12.1-22.3)

West Virginia 1 111 3.6 0 – –

Wisconsin 2 601 5.4 (5.0-5.7) 0 – –

Total 87 74,535 6.0 (0.0-44.8) 57 23,438 14.2 (3.7-33.7)

Table AA. Chlamydia — Positivity among men and women in juvenile corrections facilities, 2005

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.
STD Surveillance 2005 Special Focus Profiles STDs in Persons Entering Corrections Facilities 85

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 0 – – 1 819 15.3

California* 6 4,784 4.2 (3.3-6.9) 6 7,109 8.4 (5.0-20.4)

Colorado 1 254 19.3 1 154 19.5

Delaware 0 – – 1 448 4.7

Georgia 1 101 20.8 1 4,622 8.0

Hawaii 0 – – 2 290 12.3 (3.1-21.4)

Illinois 5 14,365 10.0 (8.1-12.0) 4 10,290 8.4 (5.7-10.4)

Iowa 2 894 11.2 (10.8-11.7) 2 677 8.3 (2.0-14.6)

Kentucky 0 – – 1 510 4.3

Massachusetts 2 3,826 5.3 (4.7-6.0) 3 1,220 3.4 (3.3-4.7)

Michigan 1 320 13.1 0 – –

Missouri 1 4,296 7.4 2 800 4.8 (3.6-6.0)

Montana 0 – – 1 269 2.6

Nebraska 4 2,301 7.0 (6.6-19.2) 1 303 17.2

Nevada 1 178 16.3 1 149 17.4

New York 2 8,349 7.5 (4.0-11.1) 1 282 6.4

North Dakota 1 565 8.1 0 – –

Oregon 1 145 15.9 1 231 9.5

Pennsylvania 3 18,702 5.7 (2.4-7.5) 1 3,160 9.5

South Carolina 1 290 12.8 1 112 5.4

Texas 1 623 16.2 2 1,424 13.3 (9.3-17.3)

Utah 0 – – 1 106 20.8

Washington 0 – – 1 1,285 4.4

West Virginia 2 765 4.4 (2.3-6.5) 0 – –

Wisconsin 6 5,839 9.7 (5.5-17.2) 3 1,279 6.4 (1.7-7.2)

Total 41 66,597 8.1 (2.3-20.8) 38 35,539 7.4 (1.7-21.4)

Table BB. Chlamydia — Positivity among men and women in adult corrections facilities, 2005

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.
86 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2005

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 3 4,580 0.9 (0.6-1.2) 3 1,633 4.8 (2.5-7.0)

California* 8 19,732 0.6 (0.2-19.0) 7 6,101 4.2 (1.1-11.7)

Colorado 2 275 1.1 (0.0-2.3) 0 – –

Connecticut 1 505 0.4 2 241 1.7 (1.6-1.8)

Delaware 1 880 1.4 1 227 3.5

Georgia 1 1,178 3.1 1 763 12.8

Hawaii 1 138 0.0 1 114 3.5

Illinois 3 5,161 2.9 (1.1-3.4) 1 559 11.1

Indiana 1 1,416 2.0 1 475 7.2

Kentucky 7 1,752 0.6 (0.0-2.5) 1 188 2.1

Massachusetts 5 2,499 1.6 (0.5-2.2) 1 414 5.8

Michigan 3 753 2.5 (1.0-3.8) 2 315 5.1 (4.8-5.3)

Mississippi 1 396 2.3 2 384 8.8 (8.4-9.2)

Missouri 1 463 2.4 1 116 8.6

Nebraska 1 959 1.1 1 317 2.5

Nevada 2 952 2.0 (0.3-3.7) 2 306 6.2 (2.3-10.1)

New Jersey 3 2,593 2.1 (0.7-2.8) 1 214 7.5

New Mexico 1 414 1.2 0 – –

New York 3 2,304 1.5 (0.0-1.8) 1 419 4.1

Ohio 1 972 3.2 2 366 8.1 (1.9-14.2)

Pennsylvania 4 3,091 0.9 (0.0-3.3) 1 388 3.9

Texas 3 6,748 0.9 (0.0-1.0) 2 1,729 6.6 (5.6-7.5)

Utah 2 721 1.0 (0.8-1.1) 2 386 2.3 (2.2-2.4)

Washington 4 965 0.4 (0.0-0.9) 2 254 4.2 (0.9-7.5)

West Virginia 1 117 2.6 0 – –

Wisconsin 2 598 1.2 (0.0-2.4) 0 – –

Total 65 60,162 1.0 (0.0-19.0) 38 15,909 4.7 (0.9-14.2)

Table CC. Gonorrhea — Positivity among men and women in juvenile corrections facilities, 2005

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco.

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 0 – – 1 820 6.6

California* 6 4,409 2.1 (0.8-3.5) 5 7,003 3.0 (1.1-13.8)

Colorado 1 254 7.9 1 154 7.1

Delaware 0 – – 1 430 1.4

Georgia 0 – – 1 4,605 3.3

Hawaii 0 – – 2 290 4.5 (0.6-8.4)

Illinois 5 14,364 3.4 (1.6-5.1) 4 10,290 4.6 (1.3-6.8)

Iowa 2 894 0.9 (0.8-1.0) 2 677 0.2 (0.0-0.4)

Kentucky 0 – – 1 510 0.8

Michigan 1 225 2.2 0 – –

Missouri 1 4,299 1.7 2 800 1.5 (0.9-2.2)

Montana 0 – – 1 267 0.0

Nebraska 4 2,301 0.4 (0.0-7.2) 1 303 5.0

Nevada 1 178 11.8 1 149 9.4

New York 1 7,393 0.4 (0.4-0.4) 0 – –

Pennsylvania 3 18,679 0.6 (0.0-1.2) 1 3,159 3.6

South Carolina 1 290 5.5 1 112 6.3

Texas 1 623 5.5 2 1,424 4.2 (2.5-5.8)

Utah 0 – – 1 106 7.5

Washington 0 – – 1 1,282 1.4

West Virginia 2 770 4.3 (2.3-6.4) 1 110 0.0 (0.0-0.0)

Wisconsin 6 5,835 2.6 (0.3-9.0) 3 1,275 2.7 (0.2-2.8)

Total 35 60,514 2.3 (0.0-11.8) 33 33,766 2.8 (0.0-13.8)

Table DD. Gonorrhea — Positivity among men and women in adult corrections facilities, 2005

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.
STD Surveillance 2005 Special Focus Profiles STDs in Persons Entering Corrections Facilities 87

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

California* 3 12,690 0.5 (0.3-0.6) 3 2,982 1.3 (0.8-1.6)

Mississippi 1 856 6.9 2 1,119 10.5 (6.4-14.6)

Ohio 1 1,654 6.0 1 135 0.0

Pennsylvania 1 4,811 0.0 1 748 0.1

Texas 2 1,257 0.6 (0.5-0.7) 2 366 2.8 (0.6-5.1)

Total 8 21,268 0.6 (0.0-6.9) 9 5,350 1.3 (0.0-14.6)

Table EE. Syphilis— Positivity among men and women in juvenile corrections facilities, 2005

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes San Francisco project area.

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

California* 6 997 4.5 (2.0-6.7) 2 323 4.3 (3.4-5.2)

Illinois 1 65,421 1.0 1 10,671 3.3

Maryland 1 13,606 2.7 1 4,455 8.9

Massachusetts 1 3,609 0.8 1 522 1.3

Mississippi 6 1,963 7.3 (4.6-9.5) 0 – –

North Carolina 5 3,318 2.6 (1.3-4.8) 5 1,085 8.6 (6.3-12.6)

New Jersey 1 11,431 2.8 1 2,178 3.0

New York† 0 – – 1 10,974 2.6

Ohio 1 29,428 8.5 1 5,431 1.8

Pennsylvania 0 – – 1 4,422 10.9

Tennessee 3 14,062 2.0 (1.9-5.5) 3 6,560 3.6 (2.8-12.5)

Texas 6 60,447 2.5 (0.9-3.5) 5 17,102 6.3 (3.1-6.6)

Wisconsin 1 1,141 0.4 1 588 1.2

Total 32 205,423 3.7 (0.4-9.5) 23 64,311 5.2 (1.2-12.6)

Table FF. Syphilis— Positivity among men and women in adult corrections facilities, 2005

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes San Francisco project area. †New York data is

for confirmatory results.

TABLES
TABLES
STD Surveillance 2005 National Summary Tables 89

Syphilis

All Stages

Primary

and

Secondary

Early

Latent

Late and

Late Latent† Neurosyphilis Congenital Chlamydia Gonorrhea Chancroid

Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 NR . 17,600 13.4 NR . 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 NR . 16,918 12.8 NR . 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 NR . 16,164 12.6 NR . 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 NR . 13,578 10.7 NR . 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 NR . 12,339 9.7 NR . 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 NR . 12,106 9.0 NR . 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 NR . 12,200 8.7 NR . 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 NR . 13,931 9.7 NR . 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 NR . 13,952 9.5 NR . 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 NR . 13,377 9.0 NR . 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 NR . 11,094 7.4 NR . 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 NR . 8,553 5.6 NR . 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 NR . 7,675 5.0 NR . 238,340 153.9 3,338 2.2

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 NR . 6,676 4.2 NR . 242,050 153.5 3,003 1.9

1955 122,392 76.2 6,454 4.0 20,054 12.5 86,526 53.8 NR . 5,354 3.3 NR . 236,197 147.0 2,649 1.7

1956 130,201 78.7 6,392 3.9 19,783 12.0 95,097 57.5 NR . 5,491 3.3 NR . 224,346 135.7 2,135 1.3

1957 123,758 73.5 6,576 3.9 17,796 10.6 91,309 54.2 NR . 5,288 3.1 NR . 214,496 127.4 1,637 1.0

1958 113,884 66.4 7,176 4.2 16,556 9.7 83,027 48.4 NR . 4,866 2.8 NR . 232,386 135.6 1,595 0.9

1959 120,824 69.2 9,799 5.6 17,025 9.8 86,740 49.7 NR . 5,130 2.9 NR . 240,254 137.6 1,537 0.9

1960 122,538 68.8 16,145 9.1 18,017 10.1 81,798 45.9 NR . 4,416 2.5 NR . 258,933 145.4 1,680 0.9

1961 124,658 68.8 19,851 11.0 19,486 10.8 79,304 43.8 NR . 4,163 2.3 NR . 264,158 145.8 1,438 0.8

1962 126,245 68.7 21,067 11.5 19,585 10.7 79,533 43.3 NR . 4,070 2.2 NR . 263,714 143.6 1,344 0.7

1963 124,137 66.6 22,251 11.9 18,235 9.8 78,076 41.9 NR . 4,031 2.2 NR . 278,289 149.2 1,220 0.7

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 NR . 3,516 1.9 NR . 300,666 159.0 1,247 0.7

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 NR . 3,564 1.9 NR . 324,925 169.6 982 0.5

1966 105,159 54.4 21,414 11.1 15,950 8.2 63,541 32.9 NR . 3,170 1.6 NR . 351,738 181.9 838 0.4

1967 102,581 52.5 21,053 10.8 15,554 8.0 61,975 31.7 NR . 2,894 1.5 NR . 404,836 207.3 784 0.4

1968 96,271 48.8 19,019 9.6 15,150 7.7 58,564 29.7 NR . 2,381 1.2 NR . 464,543 235.7 845 0.4

1969 92,162 46.3 19,130 9.6 15,402 7.7 54,587 27.4 NR . 2,074 1.0 NR . 534,872 268.6 1,104 0.6

1970 91,382 45.3 21,982 10.9 16,311 8.1 50,348 24.9 NR . 1,953 1.0 NR . 600,072 297.2 1,416 0.7

1971 95,997 46.9 23,783 11.6 19,417 9.5 49,993 24.4 NR . 2,052 1.0 NR . 670,268 327.2 1,320 0.6

1972 91,149 43.9 24,429 11.8 20,784 10.0 43,456 20.9 NR . 1,758 0.8 NR . 767,215 369.7 1,414 0.7

1973 87,469 41.7 24,825 11.8 23,584 11.3 37,054 17.7 NR . 1,527 0.7 NR . 842,621 402.0 1,165 0.6

1974 83,771 39.6 25,385 12.0 25,124 11.9 31,854 15.1 NR . 1,138 0.5 NR . 906,121 428.2 945 0.4

1975 80,356 37.6 25,561 12.0 26,569 12.4 27,096 12.7 NR . 916 0.4 NR . 999,937 467.7 700 0.3

1976 71,761 33.2 23,731 11.0 25,363 11.7 21,905 10.1 NR . 626 0.3 NR . 1001994 464.1 628 0.3

1977 64,621 29.6 20,399 9.4 21,329 9.8 22,313 10.2 NR . 463 0.2 NR . 1002219 459.5 455 0.2

1978 64,875 29.4 21,656 9.8 19,628 8.9 23,038 10.4 NR . 434 0.2 NR . 1013436 459.7 521 0.2

1979 67,049 30.1 24,874 11.2 20,459 9.2 21,301 9.6 NR . 332 0.1 NR . 1004058 450.3 840 0.4

1980 68,832 30.5 27,204 12.1 20,297 9.0 20,979 9.3 NR . 277 0.1 NR . 1004029 445.1 788 0.3

1981 72,799 32.0 31,266 13.7 21,033 9.2 20,168 8.9 NR . 287 0.1 NR . 990,864 435.2 850 0.4

1982 75,579 32.9 33,613 14.6 21,894 9.5 19,799 8.6 NR . 259 0.1 NR . 960,633 417.9 1,392 0.6

1983 74,637 32.1 32,698 14.1 23,738 10.2 17,896 7.7 NR . 239 0.1 NR . 900,435 387.6 847 0.4

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 NR . 305 0.1 7,594 6.5 878,556 372.5 665 0.3

1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 NR . 329 0.1 25,848 17.4 911,419 383.0 2,067 0.9

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000

population: United States, 1941–2005
90 National Summary Tables STD Surveillance 2005

Syphilis

All Stages

Primary

and

Secondary

Early

Latent

Late and

Late Latent† Neurosyphilis Congenital Chlamydia Gonorrhea Chancroid

Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 NR . 410 0.2 58,001 35.2 892,229 371.5 3,045 1.3

1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 NR . 480 0.2 91,913 50.8 787,532 325.0 4,986 2.1

1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 NR . 741 0.3 157,854 87.1 738,160 301.9 4,891 2.0

1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 NR . 1,837 0.7 200,904 102.5 733,294 297.1 4,697 1.9

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 NR . 3,865 1.5 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 NR . 4,424 1.7 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 NR . 4,067 1.6 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 NR . 3,420 1.3 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 NR . 2,452 0.9 451,785 192.5 419,602 163.9 782 0.3

1995 69,358 26.0 16,543 6.2 26,657 10.0 24,296 9.1 NR . 1,862 0.7 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 NR . 1,282 0.5 492,631 190.6 328,169 121.8 386 0.1

1997 46,715 17.1 8,556 3.1 16,631 6.1 20,447 7.5 193 0.1 1,081 0.4 537,904 205.5 327,665 120.2 246 0.1

1998 38,290 13.9 7,007 2.5 12,696 4.6 17,743 6.4 279 0.1 844 0.3 614,250 231.8 356,492 129.2 189 0.1

1999 35,383 12.7 6,617 2.4 11,534 4.1 16,653 6.0 341 0.1 579 0.2 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 334 0.1 580 0.2 709,452 251.4 363,136 128.7 78 0.0

2001 32,283 11.3 6,103 2.1 8,701 3.0 16,976 5.9 324 0.1 503 0.2 783,242 274.5 361,705 126.8 38 0.0

2002 32,918 11.4 6,862 2.4 8,429 2.9 17,168 6.0 387 0.1 459 0.2 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 541 0.2 432 0.1 877,478 301.7 335,104 115.2 54 0.0

2004 33,419 11.4 7,980 2.7 7,768 2.6 17,300 5.9 833 0.3 371 0.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,278 11.3 8,724 3.0 8,176 2.8 16,049 5.5 828 0.3 329 0.1 976,445 332.5 339,593 115.6 17 0.0

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000

population: United States, 1941–2005 (continued)

*For 1941-1946, data were reported for the federal fiscal year ending June 30 of the year indicated. From 1947 to the present, data were reported for

the calendar year ending December 31. For 1941-1958, data for Alaska and Hawaii were not included.

†

Late and late latent syphilis includes cases of unknown duration, late syphilis with clinical manifestations, and neurosyphilis.

§

For 1941-1994, rates include all cases of congenitally acquired syphilis per 100,000 population. As of 1995, rates of congenital syphilis 1 year of

age per 100,000 population are reported. For rates of congenital syphilis 1 year of age per 100,000 live births see Tables 37-40. As of 1995,

cases of congenital syphilis 1 year of age are obtained in hardcopy and electronic format based on case reporting form CDC 73.126.

Note: Adjustments to the number of cases reported from state health departments were made for hardcopy forms and for electronic data submissions

through June 7, 2006 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. Cases and

rates shown in this table exclude the outlying areas of Guam, Puerto Rico and Virgin Islands.

NR = No report.
STD Surveillance 2005 Chlamydia Tables 91

Rank* State Cases Rate per 100,000 Population

1 Mississippi 21,268 732.6

2 Alaska 4,355 664.4

3 New Mexico 8,456 444.3

4 South Carolina 18,296 435.8

5 Hawaii 5,489 434.7

6 Delaware 3,392 408.5

7 Illinois 50,559 397.7

8 Tennessee 23,084 391.2

9 Missouri 22,371 388.7

10 Michigan 38,730 383.0

11 Ohio 43,806 382.3

12 Louisiana 17,227 381.5

13 Oklahoma 13,407 380.5

14 Georgia 33,562 380.1

15 Alabama 17,109 377.7

16 Wisconsin 20,461 371.4

17 Arizona 21,264 370.2

18 North Carolina 31,183 365.1

19 California 130,716 364.2

20 South Dakota 2,701 350.4

21 Colorado 15,432 335.4

22 New York 63,966 332.7

U.S. TOTAL† 976,445 332.5

23 Maryland 18,291 329.1

24 Indiana 20,063 321.6

25 Texas 71,860 319.5

26 Connecticut 11,039 315.1

27 Nevada 7,321 313.6

28 Arkansas 8,507 309.1

29 Virginia 22,668 303.9

30 Rhode Island 3,269 302.5

31 Pennsylvania 37,261 300.3

32 Washington 18,616 300.1

33 Nebraska 5,098 291.8

34 Kansas 7,419 271.2

35 North Dakota 1,667 262.8

36 Montana 2,400 258.9

37 Oregon 9,018 250.9

38 Iowa 7,390 250.1

39 Florida 43,372 249.3

40 Minnesota 12,189 239.0

41 Wyoming 1,173 231.6

42 Massachusetts 14,411 224.6

43 New Jersey 19,152 220.2

44 Kentucky 8,351 201.4

45 Idaho 2,799 200.9

46 Utah 4,602 192.6

47 Maine 2,254 171.1

48 West Virginia 2,944 162.2

49 Vermont 957 154.0

50 New Hampshire 1,842 141.7

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates: United States, 2005

*

States were ranked in descending order by rate, number of cases, and alphabetically by state.

†

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 807 cases and rate of 485.9, Puerto Rico with 3,714

cases and rate of 95.4, and Virgin Islands with 235 cases and rate of 216.0).
92 Chlamydia Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 14,524 15,611 14,209 13,314 17,109 325.0 348.0 315.7 293.9 377.7

Alaska 2,744 3,806 3,900 3,954 4,355 433.1 591.2 601.1 603.3 664.4

Arizona 14,346 14,973 12,819 16,786 21,264 270.3 274.4 229.7 292.2 370.2

Arkansas 7,280 7,312 7,856 7,864 8,507 270.2 269.8 288.2 285.7 309.1

California 101,944 110,288 117,428 122,197 130,716 294.6 314.1 330.9 340.4 364.2

Colorado 13,239 14,028 13,039 14,151 15,432 298.8 311.3 286.5 307.5 335.4

Connecticut 7,718 9,808 9,393 9,552 11,039 224.7 283.4 269.7 272.6 315.1

Delaware 2,793 2,649 3,035 2,954 3,392 350.6 328.1 371.3 355.7 408.5

Florida 37,625 42,058 42,382 42,554 43,372 229.8 251.6 249.0 244.6 249.3

Georgia 33,840 33,998 35,686 34,280 33,562 402.6 397.2 410.9 388.2 380.1

Hawaii 4,031 4,521 5,480 5,307 5,489 328.5 363.2 435.7 420.2 434.7

Idaho 2,023 2,503 2,366 2,784 2,799 153.2 186.6 173.2 199.8 200.9

Illinois 43,716 48,101 48,294 47,185 50,559 349.2 381.7 381.7 371.1 397.7

Indiana 15,258 17,100 17,075 18,440 20,063 249.0 277.6 275.6 295.6 321.6

Iowa 5,699 6,195 6,491 6,956 7,390 194.4 210.9 220.5 235.4 250.1

Kansas 6,050 6,784 7,249 7,493 7,419 223.9 249.8 266.2 273.9 271.2

Kentucky 8,881 8,756 7,981 6,470 8,351 218.3 213.9 193.8 156.1 201.4

Louisiana 17,840 18,442 20,970 21,837 17,227 399.1 411.4 466.4 483.6 381.5

Maine 1,338 1,805 2,030 2,113 2,254 104.2 139.4 155.5 160.4 171.1

Maryland 15,640 16,891 16,831 19,952 18,291 290.4 309.5 305.5 359.0 329.1

Massachusetts 10,402 10,914 11,301 13,242 14,411 162.5 169.8 175.7 206.4 224.6

Michigan 31,090 32,272 32,572 41,246 38,730 310.7 321.1 323.1 407.9 383.0

Minnesota 8,323 10,107 10,714 11,602 12,189 167.0 201.3 211.8 227.4 239.0

Mississippi 11,793 11,800 12,193 18,863 21,268 412.4 410.9 423.2 649.8 732.6

Missouri 13,949 16,181 18,570 21,319 22,371 247.4 285.2 325.5 370.5 388.7

Montana 1,919 2,475 2,547 2,608 2,400 212.0 272.1 277.6 281.4 258.9

Nebraska 3,206 4,779 4,739 5,238 5,098 186.4 276.4 272.5 299.8 291.8

Nevada 4,831 5,936 5,830 6,690 7,321 230.3 273.1 260.1 286.5 313.6

New Hampshire 1,383 1,557 1,616 1,736 1,842 109.8 122.1 125.5 133.6 141.7

New Jersey 16,312 14,164 16,169 17,448 19,152 191.7 164.9 187.2 200.6 220.2

New Mexico 6,254 7,417 7,480 9,035 8,456 341.6 399.8 399.0 474.7 444.3

New York 46,393 51,123 57,222 59,097 63,966 243.1 266.9 298.2 307.4 332.7

North Carolina 22,101 24,726 26,187 28,967 31,183 269.3 297.2 311.5 339.1 365.1

North Dakota 1,062 1,256 1,655 1,810 1,667 166.8 198.1 261.1 285.3 262.8

Ohio 37,653 38,032 42,522 39,379 43,806 330.6 333.0 371.8 343.7 382.3

Oklahoma 10,478 10,804 11,013 10,366 13,407 302.0 309.2 313.6 294.2 380.5

Oregon 7,454 7,009 7,688 8,690 9,018 214.6 199.0 216.0 241.8 250.9

Pennsylvania 28,371 31,791 37,291 38,025 37,261 230.6 257.7 301.6 306.5 300.3

Rhode Island 2,912 2,832 3,000 3,442 3,269 274.8 264.7 278.8 318.5 302.5

South Carolina 15,329 14,314 14,623 18,423 18,296 377.4 348.5 352.6 438.8 435.8

South Dakota 1,821 2,215 2,608 2,532 2,701 240.1 291.0 341.2 328.5 350.4

Tennessee 15,560 16,042 20,380 22,515 23,084 270.6 276.7 348.9 381.5 391.2

Texas 69,752 69,521 69,200 70,232 71,860 326.4 319.2 312.9 312.3 319.5

Utah 3,004 3,540 3,893 3,857 4,602 131.8 152.8 165.6 161.4 192.6

Vermont 638 954 1,060 1,137 957 104.1 154.7 171.2 183.0 154.0

Virginia 18,337 18,518 19,439 21,635 22,668 254.8 253.9 263.2 290.0 303.9

Washington 13,631 14,934 16,797 17,635 18,616 227.4 246.1 273.9 284.3 300.1

West Virginia 2,346 2,464 2,585 2,758 2,944 130.3 136.7 142.8 151.9 162.2

Wisconsin 16,284 17,000 17,942 19,217 20,461 301.2 312.4 327.9 348.8 371.4

Wyoming 839 944 960 1,082 1,173 169.9 189.3 191.5 213.6 231.6

U.S. TOTAL* 783,242 834,555 877,478 929,462 976,445 274.5 289.4 301.7 316.5 332.5

Northeast 115,467 124,948 139,082 145,792 154,151 214.0 230.4 255.7 267.2 282.5

Midwest 184,111 200,022 210,431 222,417 232,454 284.0 307.1 321.7 338.4 353.7

South 307,405 317,211 327,738 346,477 358,199 301.5 306.9 313.5 327.0 338.1

West 176,259 192,374 200,227 214,776 231,641 272.9 293.0 301.2 318.6 343.6

Guam 431 550 554 748 807 272.2 341.5 338.6 450.4 485.9

Puerto Rico 2,748 2,999 2,746 3,588 3,714 71.6 77.7 70.8 92.1 95.4

Virgin Islands 131 207 416 303 235 119.7 188.1 382.3 278.6 216.0

OUTLYING AREAS 3,310 3,756 3,716 4,639 4,756 80.6 90.9 89.5 111.3 114.1

TOTAL 786,552 838,311 881,194 934,101 981,201 271.8 286.6 298.7 313.6 329.5

Table 3. Chlamydia — Reported cases and rates by state/area and region listed in alphabetical order: United

States and outlying areas, 2001–2005

*

Includes cases reported by Washington, D.C.

Note: Rates exclude population of states that did not report.
STD Surveillance 2005 Chlamydia Tables 93

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 13,375 13,988 12,977 11,685 14,532 579.0 603.6 559.0 500.6 622.6

Alaska 1,981 2,576 2,665 2,671 2,908 647.0 829.2 850.0 843.9 918.7

Arizona 11,193 11,665 10,043 12,896 16,201 421.3 427.2 360.1 449.3 564.5

Arkansas 5,949 5,817 6,284 6,252 6,823 431.6 419.8 451.5 445.3 486.0

California 76,261 81,218 85,967 88,439 93,646 439.5 461.5 483.7 491.9 520.8

Colorado 9,894 10,422 9,843 10,283 11,219 449.8 466.0 436.4 451.0 492.1

Connecticut 6,260 7,738 7,309 7,383 8,383 353.8 434.4 407.8 409.4 464.8

Delaware 2,125 2,034 2,155 2,140 2,493 518.8 490.1 513.9 502.7 585.6

Florida 30,647 33,902 34,581 34,437 34,850 365.9 396.9 398.2 388.1 392.8

Georgia 27,905 27,494 28,992 27,656 26,317 654.1 633.2 659.2 619.5 589.5

Hawaii 3,053 3,445 4,113 4,019 4,093 499.2 554.9 655.9 635.1 646.8

Idaho 1,469 1,862 1,762 2,157 2,162 223.0 278.2 258.5 310.5 311.2

Illinois 33,124 34,154 36,284 35,996 37,672 518.7 531.7 563.1 556.3 582.2

Indiana 11,668 13,151 13,118 14,217 15,263 374.1 419.7 416.6 448.7 481.7

Iowa 4,295 4,680 4,915 5,208 5,400 287.7 313.1 328.5 347.1 359.9

Kansas 4,977 5,653 5,989 6,195 6,054 364.4 412.0 436.1 449.9 439.6

Kentucky 7,081 7,043 6,353 5,027 6,041 340.6 336.8 302.5 238.0 286.0

Louisiana 14,416 14,758 17,046 17,549 13,395 625.3 638.8 736.6 755.8 576.9

Maine 1,040 1,337 1,452 1,532 1,644 157.7 201.3 217.0 227.3 243.9

Maryland 12,863 13,851 13,746 16,108 14,653 462.1 491.3 483.5 561.8 511.1

Massachusetts 7,897 8,177 8,429 9,781 10,587 238.3 245.9 253.7 295.5 319.8

Michigan 24,550 25,129 25,903 32,624 30,079 481.7 491.2 505.1 634.2 584.7

Minnesota 6,010 7,352 7,866 8,521 8,820 238.9 290.3 308.4 331.7 343.3

Mississippi 10,258 10,274 10,536 15,097 16,684 694.4 692.8 709.5 1,010.4 1,116.6

Missouri 11,854 13,253 14,750 16,306 16,580 409.5 455.3 504.8 553.9 563.2

Montana 1,466 1,840 1,865 1,916 1,776 322.7 403.2 405.4 412.4 382.3

Nebraska 2,521 3,609 3,435 3,812 3,713 289.2 412.1 390.3 431.4 420.2

Nevada 3,586 4,365 4,268 4,857 5,362 348.4 409.3 388.3 423.8 467.9

New Hampshire 1,042 1,168 1,196 1,265 1,343 162.9 180.4 183.1 192.1 203.9

New Jersey 14,352 12,183 13,813 14,491 15,826 327.8 275.9 311.5 324.7 354.6

New Mexico 4,891 5,918 5,973 6,876 6,333 525.4 627.6 627.3 710.9 654.8

New York 38,297 41,202 43,907 44,975 45,391 387.8 415.9 442.9 453.3 457.5

North Carolina 18,628 20,384 21,807 23,916 25,702 445.2 480.9 509.9 550.8 591.9

North Dakota 716 826 1,087 1,206 1,091 224.6 260.1 342.8 379.6 343.4

Ohio 29,521 29,558 33,549 30,377 33,312 504.2 503.7 571.6 516.8 566.7

Oklahoma 8,600 8,764 8,990 8,237 10,608 488.0 494.1 505.0 461.9 594.9

Oregon 5,442 5,033 5,590 6,090 6,194 311.0 283.8 312.1 336.9 342.6

Pennsylvania 22,521 23,546 27,557 27,740 27,131 354.3 369.7 432.1 433.9 424.4

Rhode Island 2,197 2,057 2,232 2,502 2,396 399.3 370.6 400.2 447.3 428.3

South Carolina 13,528 12,468 12,745 15,925 15,694 647.8 590.4 598.8 739.7 729.0

South Dakota 1,311 1,608 1,864 1,824 1,924 343.3 419.7 484.9 470.5 496.3

Tennessee 12,105 12,625 14,669 16,237 16,453 410.7 424.9 490.7 538.6 545.8

Texas 57,611 57,438 57,549 57,470 58,668 535.8 524.4 518.0 509.1 519.7

Utah 2,119 2,494 2,787 2,720 3,081 186.5 216.0 238.0 228.6 259.0

Vermont 523 746 828 861 725 167.3 237.3 262.8 272.8 229.7

Virginia 15,177 15,102 15,535 16,578 16,805 414.0 406.8 413.8 437.6 443.6

Washington 10,159 11,003 12,341 12,835 13,471 337.6 361.2 401.4 412.8 433.2

West Virginia 1,969 2,072 2,102 2,105 2,272 212.9 224.0 226.6 226.8 244.8

Wisconsin 12,045 12,296 12,838 13,913 14,751 440.5 446.9 464.3 500.1 530.2

Wyoming 679 755 717 820 874 276.8 304.7 288.1 326.1 347.6

U.S. TOTAL* 623,958 652,858 685,017 716,675 740,371 429.6 445.0 463.6 480.6 496.5

Northeast 94,129 98,154 106,723 110,530 113,426 337.9 350.8 380.7 393.4 403.7

Midwest 142,592 151,269 161,598 170,199 174,659 431.7 455.9 485.6 509.2 522.6

South 255,044 260,839 268,762 279,367 284,966 490.3 495.0 505.0 518.4 528.8

West 132,193 142,596 147,934 156,579 167,320 408.8 434.0 445.1 464.5 496.3

Guam 347 463 446 608 667 448.1 587.4 556.8 747.1 819.6

Puerto Rico 2,313 2,665 2,378 3,240 3,366 116.1 133.1 118.1 160.1 166.4

Virgin Islands 116 188 352 232 189 199.4 317.5 619.0 408.0 332.4

OUTLYING AREAS 2,776 3,316 3,176 4,080 4,222 130.5 154.9 147.6 188.8 195.3

TOTAL 626,734 656,174 688,193 720,755 744,593 425.3 440.8 459.0 476.4 492.2

Table 4. Chlamydia — Women – Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.

Note: Rates exclude population of states that did not report. Cases reported with unknown sex are not included in this table.
94 Chlamydia Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 1,124 1,579 1,201 1,603 2,507 52.1 72.8 55.1 73.0 114.2

Alaska 763 1,230 1,235 1,283 1,447 233.0 369.2 368.3 378.6 427.0

Arizona 3,153 3,308 2,772 3,884 5,058 119.0 121.4 99.3 135.2 176.0

Arkansas 1,325 1,486 1,567 1,612 1,684 100.7 112.2 117.5 119.5 124.9

California 24,930 28,400 31,238 33,323 36,449 144.5 162.1 176.4 186.0 203.5

Colorado 3,328 3,604 3,196 3,855 4,213 149.1 158.8 139.2 166.1 181.5

Connecticut 1,445 2,070 2,084 2,168 2,656 86.8 123.3 123.2 127.5 156.2

Delaware 668 615 880 814 899 172.6 156.7 221.0 201.1 222.2

Florida 6,967 8,156 7,801 8,117 8,522 87.1 99.8 93.6 95.2 100.0

Georgia 5,926 6,363 6,509 6,411 6,793 143.2 150.9 151.8 146.9 155.6

Hawaii 977 1,076 1,367 1,288 1,396 158.7 172.4 216.8 204.4 221.6

Idaho 528 641 604 617 616 79.8 95.4 88.2 88.3 88.2

Illinois 10,588 13,942 12,009 11,187 12,886 172.6 225.7 193.4 179.2 206.4

Indiana 3,555 3,845 3,803 4,080 4,703 118.2 127.1 124.8 132.9 153.2

Iowa 1,401 1,505 1,561 1,743 1,990 97.3 104.4 107.8 119.9 136.9

Kansas 1,073 1,131 1,260 1,298 1,365 80.3 84.2 93.3 95.6 100.5

Kentucky 1,779 1,706 1,613 1,433 2,285 89.4 85.2 79.9 70.5 112.3

Louisiana 3,424 3,525 3,808 4,016 3,583 158.1 162.3 174.5 183.0 163.3

Maine 297 468 577 581 606 47.5 74.3 90.6 90.3 94.2

Maryland 2,777 3,029 3,068 3,841 3,627 106.7 114.8 115.1 142.7 134.8

Massachusetts 2,502 2,724 2,848 3,449 3,809 81.1 87.8 91.6 111.0 122.6

Michigan 6,540 7,143 6,669 8,622 8,525 133.2 144.8 134.7 173.5 171.6

Minnesota 2,313 2,755 2,848 3,081 3,369 93.7 110.8 113.5 121.7 133.1

Mississippi 1,535 1,526 1,657 3,766 4,584 111.0 109.9 118.7 267.3 325.4

Missouri 2,095 2,928 3,820 5,013 5,791 76.4 106.0 137.3 178.3 206.0

Montana 449 625 679 685 619 99.5 137.9 148.4 148.2 133.9

Nebraska 680 1,128 1,244 1,391 1,378 80.1 132.2 144.8 161.1 159.6

Nevada 1,239 1,558 1,552 1,821 1,955 115.9 140.7 135.9 153.2 164.5

New Hampshire 341 389 420 471 499 55.0 62.0 66.2 73.5 77.9

New Jersey 1,948 1,962 2,332 2,945 3,323 47.1 47.0 55.5 69.5 78.4

New Mexico 1,237 1,464 1,485 2,151 2,121 137.4 160.5 161.0 229.8 226.6

New York 8,042 9,885 13,106 14,031 18,547 87.3 106.8 141.3 150.8 199.3

North Carolina 3,473 4,340 4,379 5,051 5,481 86.4 106.3 106.0 120.3 130.5

North Dakota 346 429 567 601 574 108.9 135.5 179.0 189.8 181.3

Ohio 7,603 7,926 8,215 8,189 9,139 137.4 142.7 147.6 146.7 163.8

Oklahoma 1,878 2,040 2,023 2,129 2,799 110.0 118.6 116.8 122.3 160.8

Oregon 2,012 1,976 2,098 2,600 2,824 116.7 113.1 118.6 145.5 158.1

Pennsylvania 5,850 8,244 9,682 10,282 10,128 98.4 138.2 161.7 171.0 168.4

Rhode Island 715 775 768 936 868 140.3 150.6 148.1 179.6 166.5

South Carolina 1,731 1,800 1,813 2,456 2,572 87.7 90.2 89.8 120.1 125.8

South Dakota 510 606 742 708 774 135.5 160.3 195.3 184.7 202.0

Tennessee 3,455 3,417 5,711 6,278 6,619 123.3 120.9 200.2 217.5 229.3

Texas 12,033 11,964 11,594 12,619 13,138 113.3 110.5 105.3 112.7 117.3

Utah 882 1,044 1,103 1,137 1,521 77.2 89.9 93.4 94.8 126.8

Vermont 115 208 232 276 232 38.3 68.8 76.3 90.3 75.9

Virginia 3,107 3,416 3,868 5,024 5,823 88.0 95.4 106.5 136.8 158.6

Washington 3,472 3,931 4,456 4,800 5,145 116.3 130.0 145.8 155.1 166.3

West Virginia 371 386 472 649 671 42.3 44.0 53.5 73.1 75.6

Wisconsin 4,191 4,669 5,015 5,290 5,688 156.9 173.6 185.2 194.0 208.6

Wyoming 160 189 243 262 299 64.4 75.3 96.3 102.7 117.2

U.S. TOTAL* 157,304 179,585 190,244 210,396 232,781 112.3 126.8 133.0 145.6 161.1

Northeast 21,255 26,725 32,049 35,139 40,668 81.5 101.8 121.6 132.7 153.6

Midwest 40,895 48,007 47,753 51,203 56,182 128.7 150.2 148.6 158.5 173.9

South 52,024 55,807 58,414 66,348 72,268 104.2 110.2 113.8 127.4 138.8

West 43,130 49,046 52,028 57,706 63,663 133.7 149.5 156.6 171.2 188.9

Guam 84 87 108 140 140 103.8 105.8 129.4 165.3 165.3

Puerto Rico 435 334 368 348 348 23.5 18.0 19.7 18.6 18.6

Virgin Islands 15 19 64 71 46 29.3 37.4 123.2 136.8 88.6

OUTLYING AREAS 534 440 540 559 534 27.0 22.1 27.0 27.8 26.6

TOTAL 157,838 180,025 190,784 210,955 233,315 111.1 125.3 131.5 144.0 159.2

Table 5. Chlamydia — Men – Reported cases and rates by state/area and region listed in alphabetical order:

United States and outlying areas, 2001–2005

*

Includes cases reported by Washington, D.C.

Note: Rates exclude population of states that did not report. Cases reported with unknown sex are not included in this table.
STD Surveillance 2005 Chlamydia Tables 95

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 16,564 18,135 17,068 16,748 NA 365.7 393.4 362.5 355.7

Austin-Round Rock, TX 4,458 4,716 4,456 4,580 5,103 337.1 349.5 323.5 324.3 361.3

Baltimore-Towson, MD NA 9,598 10,044 10,959 11,071 NA 368.9 383.9 415.2 419.5

Birmingham-Hoover, AL 3,420 4,173 3,189 3,905 4,720 322.1 390.7 297.3 360.8 436.2

Boston-Cambridge-Quincy, MA-NH NA 7,350 7,831 9,006 9,368 NA 165.3 176.4 203.5 211.7

Buffalo-Cheektowaga-Tonawanda, NY NA 3,295 3,513 4,865 5,013 NA 283.3 303.0 421.4 434.3

Charlotte-Gastonia-Concord, NC-SC 3,371 4,105 4,619 4,832 5,830 244.9 291.1 321.3 327.7 395.3

Chicago-Naperville-Joliet, IL-IN-WI NA 38,503 37,017 35,953 38,966 NA 414.6 396.6 382.8 414.9

Cincinnati-Middletown, OH-KY-IN 6,522 6,408 6,789 6,438 8,516 321.6 314.0 331.6 312.8 413.8

Cleveland-Elyria-Mentor, OH 7,494 7,618 8,489 7,867 8,181 349.1 354.7 396.8 368.1 382.8

Columbus, OH 6,364 5,996 5,758 5,167 5,902 387.7 361.2 343.8 305.0 348.4

Dallas-Fort Worth-Arlington, TX 16,716 15,800 16,828 15,744 18,005 312.1 288.1 301.1 276.2 315.9

Denver-Aurora, CO 7,299 7,952 7,039 7,774 8,534 324.9 348.7 305.9 333.6 366.2

Detroit-Warren-Livonia, MI 15,806 16,518 16,071 21,378 20,497 353.3 368.4 358.4 475.8 456.2

Hartford-West Hartford-East Hartford, CT 3,146 3,535 3,224 3,040 3,815 271.4 302.6 273.7 256.6 322.1

Houston-Baytown-Sugar Land, TX 14,252 14,926 13,530 14,796 13,476 293.4 299.3 266.6 285.6 260.1

Indianapolis, IN 7,131 7,302 7,304 6,922 8,226 459.0 463.7 457.8 426.9 507.3

Jacksonville, FL 4,067 4,430 5,200 5,017 5,246 353.5 376.2 432.3 409.4 428.1

Kansas City, MO-KS 5,075 6,006 7,105 8,003 7,900 272.2 317.9 373.0 415.7 410.3

Las Vegas-Paradise, NV 3,392 4,446 4,379 5,065 5,623 232.4 292.1 277.8 306.8 340.6

Los Angeles-Long Beach-Santa Ana, CA NA 43,482 46,342 46,202 50,703 NA 341.2 361.2 357.5 392.3

Louisville, KY-IN 2,547 2,796 2,775 2,396 3,143 217.0 236.4 233.2 199.5 261.7

Memphis, TN-MS-AR 6,305 6,381 7,362 8,927 9,457 517.7 518.5 594.0 714.0 756.4

Miami-Fort Lauderdale-Miami Beach, FL 9,483 10,867 11,024 11,781 10,403 184.8 207.7 208.4 219.7 194.0

Milwaukee-Waukesha-West Allis, WI NA 9,291 9,320 10,070 10,368 NA 614.3 615.5 664.4 684.0

Minneapolis-St. Paul-Bloomington, MN-WI NA 7,678 8,081 8,139 8,513 NA 251.4 262.1 261.2 273.2

Nashville-Davidson-Murfreesboro, TN 3,083 3,172 3,981 4,243 4,538 230.8 234.4 290.3 304.0 325.1

New Orleans-Metairie-Kenner, LA NA 6,258 7,116 6,858 4,761 NA 475.8 540.1 519.7 360.8

New York-Newark-Edison, NY-NJ-PA NA 46,925 51,614 52,266 58,134 NA 252.2 276.9 279.4 310.7

Oklahoma City, OK 3,907 4,149 4,124 3,939 4,798 352.7 370.0 364.1 344.2 419.3

Orlando, FL 4,250 4,323 4,673 4,888 5,862 249.1 246.7 259.2 262.6 314.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 20,989 25,347 25,285 24,913 NA 364.9 439.1 435.9 429.5

Phoenix-Mesa-Scottsdale, AZ NA NA 8,084 11,078 11,984 NA NA 225.0 298.2 322.6

Pittsburgh, PA NA 5,272 5,499 5,539 5,880 NA 218.0 228.1 230.6 244.8

Portland-Vancouver-Beaverton, OR-WA 4,558 4,363 4,703 5,256 5,636 230.4 216.4 230.5 254.6 273.0

Providence-New Bedford-Fall River, RI-MA NA 3,574 3,714 4,269 4,316 NA 221.6 228.8 262.1 265.0

Richmond, VA 3,831 4,384 4,472 4,923 4,710 344.4 389.3 392.9 426.5 408.0

Riverside-San Bernardino-Ontario, CA NA 10,077 10,688 10,913 12,179 NA 286.7 293.4 287.7 321.1

Rochester, NY NA 2,453 4,142 4,040 3,850 NA 235.2 397.8 387.9 369.7

Sacramento-Arden-Arcade-Roseville, CA NA 5,547 6,240 7,294 8,175 NA 287.4 316.0 361.7 405.4

Salt Lake City, UT 1,746 2,160 2,264 2,223 2,642 177.2 216.6 225.2 218.2 259.3

San Antonio, TX 6,111 6,365 7,212 7,645 8,049 349.2 356.3 396.1 412.3 434.1

San Diego-Carlsbad-San Marcos, CA NA 10,286 10,432 10,876 11,520 NA 353.9 355.9 371.0 392.9

San Francisco-Oakland-Fremont, CA NA 12,272 12,774 13,580 13,988 NA 293.6 307.3 326.9 336.7

San Jose-Sunnyvale-Santa Clara, CA NA 4,465 4,796 5,697 5,374 NA 256.7 276.5 327.1 308.6

Seattle-Tacoma-Bellevue, WA 7,980 8,497 9,457 9,655 10,588 257.7 271.8 301.0 304.9 334.3

St. Louis, MO-IL 8,543 9,218 10,081 11,856 13,328 314.6 337.8 368.5 428.9 482.2

Tampa-St. Petersburg-Clearwater, FL 4,955 6,322 6,002 5,996 6,315 202.6 253.9 237.1 231.7 244.0

Virginia Beach-Norfolk-Newport News, VA-NC 6,156 6,137 6,668 7,601 8,414 386.7 380.5 407.3 462.3 511.7

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 11,715 11,230 14,046 12,827 NA 233.1 220.6 273.3 249.6

U.S. MSA TOTAL 181,968 468,659 500,737 525,860 556,108 298.1 309.6 320.5 333.0 352.2

Table 6. Chlamydia — Reported cases and rates in selected metropolitan statistical areas* (MSAs) listed in

alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
96 Chlamydia Tables STD Surveillance 2005

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 13,071 14,519 13,756 12,995 NA 570.8 624.4 580.4 548.3

Austin-Round Rock, TX 3,626 3,792 3,418 3,405 3,720 557.4 571.4 506.4 492.5 538.0

Baltimore-Towson, MD NA 8,091 8,412 9,051 8,927 NA 599.7 620.5 662.1 653.0

Birmingham-Hoover, AL 2,957 3,321 2,825 3,095 3,709 536.2 599.2 508.3 552.6 662.2

Boston-Cambridge-Quincy, MA-NH NA 5,502 5,715 6,549 6,663 NA 239.7 249.8 287.6 292.6

Buffalo-Cheektowaga-Tonawanda, NY NA 2,502 2,677 3,698 3,849 NA 413.6 444.3 616.7 641.8

Charlotte-Gastonia-Concord, NC-SC 2,801 3,380 3,915 4,059 4,878 399.6 471.2 536.5 541.9 651.2

Chicago-Naperville-Joliet, IL-IN-WI NA 26,625 27,419 27,271 28,860 NA 561.8 576.5 570.2 603.4

Cincinnati-Middletown, OH-KY-IN 5,350 5,244 5,458 5,108 6,580 513.4 500.5 520.2 484.6 624.2

Cleveland-Elyria-Mentor, OH 5,729 5,805 6,548 5,909 6,066 512.0 518.8 588.0 531.6 545.8

Columbus, OH 4,473 4,189 4,525 4,058 4,445 535.8 496.5 532.1 472.8 517.8

Dallas-Fort Worth-Arlington, TX 13,307 12,544 13,633 12,536 14,641 495.7 456.8 488.3 440.7 514.7

Denver-Aurora, CO 5,344 5,777 5,225 5,558 6,122 476.4 507.6 455.8 479.3 528.0

Detroit-Warren-Livonia, MI 12,664 12,883 13,008 17,145 16,172 551.0 559.6 565.6 744.1 701.8

Hartford-West Hartford-East Hartford, CT 2,493 2,749 2,510 2,331 2,842 417.2 456.8 413.6 381.9 465.6

Houston-Baytown-Sugar Land, TX 12,042 12,490 11,325 12,258 11,539 494.4 499.8 446.0 473.1 445.4

Indianapolis, IN 4,952 5,188 5,337 5,167 5,949 624.1 645.7 656.5 625.9 720.6

Jacksonville, FL 3,306 3,403 4,051 3,759 4,021 560.9 564.6 658.1 600.4 642.2

Kansas City, MO-KS 4,346 5,022 5,434 5,993 5,930 455.9 520.3 559.4 611.3 604.9

Las Vegas-Paradise, NV 2,626 3,363 3,318 3,820 4,319 366.1 449.5 428.5 471.0 532.5

Los Angeles-Long Beach-Santa Ana, CA NA 31,411 33,124 32,903 36,044 NA 488.6 511.9 504.6 552.8

Louisville, KY-IN 2,035 2,245 2,144 1,817 2,232 337.1 369.1 351.2 295.1 362.5

Memphis, TN-MS-AR 5,126 5,258 5,650 6,816 7,150 810.7 823.5 880.2 1,053.0 1,104.6

Miami-Fort Lauderdale-Miami Beach, FL 7,693 8,647 9,027 9,610 8,492 290.3 320.4 331.4 347.8 307.4

Milwaukee-Waukesha-West Allis, WI NA 6,829 6,756 7,358 7,558 NA 877.5 868.3 945.2 970.9

Minneapolis-St. Paul-Bloomington, MN-WI NA 5,441 5,792 5,892 6,022 NA 352.2 371.9 374.8 383.0

Nashville-Davidson-Murfreesboro, TN 2,339 2,385 2,834 3,018 3,122 343.5 345.9 406.9 426.5 441.2

New Orleans-Metairie-Kenner, LA NA 4,870 5,736 5,433 3,563 NA 710.6 836.7 791.6 519.1

New York-Newark-Edison, NY-NJ-PA NA 38,786 40,956 41,039 42,214 NA 401.5 423.7 423.4 435.5

Oklahoma City, OK 3,150 3,224 3,301 3,057 3,744 558.6 565.2 573.5 527.5 646.0

Orlando, FL 3,490 3,521 3,852 3,993 4,667 403.3 396.6 421.9 424.0 495.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 15,523 18,707 18,369 18,236 NA 520.2 625.3 611.6 607.2

Phoenix-Mesa-Scottsdale, AZ NA NA 6,303 8,555 9,338 NA NA 353.6 464.3 506.8

Pittsburgh, PA NA 4,081 4,191 4,185 4,398 NA 323.7 333.7 334.6 351.7

Portland-Vancouver-Beaverton, OR-WA 3,243 3,036 3,332 3,555 3,816 325.7 299.4 325.2 343.2 368.4

Providence-New Bedford-Fall River, RI-MA NA 2,621 2,784 3,138 3,225 NA 313.0 331.0 372.1 382.5

Richmond, VA 3,135 3,532 3,421 3,573 3,425 545.0 607.0 582.6 601.2 576.3

Riverside-San Bernardino-Ontario, CA NA 7,827 8,122 8,252 9,257 NA 445.7 445.9 435.4 488.5

Rochester, NY NA 1,876 2,990 2,869 2,670 NA 350.2 558.8 536.9 499.7

Sacramento-Arden-Arcade-Roseville, CA NA 4,200 4,603 5,326 5,890 NA 427.6 458.6 519.5 574.5

Salt Lake City, UT 1,172 1,473 1,574 1,501 1,709 240.0 298.1 316.8 298.1 339.4

San Antonio, TX 4,945 5,168 5,985 6,182 6,105 552.5 565.8 644.1 653.1 645.0

San Diego-Carlsbad-San Marcos, CA NA 7,285 7,694 7,908 8,210 NA 504.0 528.8 542.6 563.3

San Francisco-Oakland-Fremont, CA NA 8,560 8,824 9,151 9,217 NA 404.9 420.4 436.4 439.6

San Jose-Sunnyvale-Santa Clara, CA NA 3,239 3,465 4,038 3,752 NA 377.2 406.0 471.7 438.3

Seattle-Tacoma-Bellevue, WA 5,609 5,946 6,606 6,775 7,411 360.9 379.0 419.5 427.2 467.3

St. Louis, MO-IL 7,219 7,411 8,179 9,086 9,804 512.9 524.3 577.7 636.1 686.4

Tampa-St. Petersburg-Clearwater, FL 4,089 5,138 4,846 4,920 5,184 323.3 399.4 371.1 369.1 388.9

Virginia Beach-Norfolk-Newport News, VA-NC 5,112 5,039 5,378 5,862 6,016 632.8 616.7 648.6 704.2 722.7

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 9,490 9,065 11,170 10,086 NA 368.3 347.6 424.8 383.5

U.S. MSA TOTAL 144,373 359,003 384,513 399,877 414,784 464.6 464.7 483.1 497.5 516.1

Table 7. Chlamydia — Women – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific case counts and

rates to be determined for some jurisdictions for some years.
STD Surveillance 2005 Chlamydia Tables 97

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 3,411 3,526 3,187 3,463 NA 152.3 154.3 136.3 148.1

Austin-Round Rock, TX 831 920 1,026 1,093 1,357 123.7 134.2 146.0 151.6 188.3

Baltimore-Towson, MD NA 1,505 1,627 1,908 2,139 NA 120.1 129.1 150.0 168.1

Birmingham-Hoover, AL 463 850 361 810 1,005 90.7 165.4 69.8 155.1 192.5

Boston-Cambridge-Quincy, MA-NH NA 1,839 2,097 2,449 2,697 NA 85.5 97.4 114.0 125.6

Buffalo-Cheektowaga-Tonawanda, NY NA 793 836 1,167 1,164 NA 142.1 150.1 210.4 209.8

Charlotte-Gastonia-Concord, NC-SC 569 721 700 770 951 84.3 104.1 98.9 106.1 131.0

Chicago-Naperville-Joliet, IL-IN-WI NA 11,860 9,542 8,602 10,075 NA 260.8 208.5 186.7 218.6

Cincinnati-Middletown, OH-KY-IN 1,130 1,117 1,268 1,239 1,746 114.6 112.5 127.0 123.4 173.9

Cleveland-Elyria-Mentor, OH 1,715 1,758 1,875 1,904 1,986 166.9 170.9 182.8 185.7 193.6

Columbus, OH 1,787 1,730 1,174 1,058 1,377 221.6 212.0 142.5 126.6 164.8

Dallas-Fort Worth-Arlington, TX 3,337 3,178 3,179 3,192 3,346 124.9 116.1 113.6 111.8 117.2

Denver-Aurora, CO 1,948 2,173 1,814 2,210 2,412 173.2 190.2 157.1 188.8 206.0

Detroit-Warren-Livonia, MI 3,142 3,635 3,063 4,233 4,256 144.4 166.6 140.3 193.4 194.4

Hartford-West Hartford-East Hartford, CT 648 786 714 708 973 115.4 138.8 125.0 123.3 169.5

Houston-Baytown-Sugar Land, TX 2,197 2,423 2,185 2,504 1,930 90.7 97.4 86.1 96.7 74.5

Indianapolis, IN 2,163 2,053 1,906 1,744 2,242 284.6 266.2 243.6 219.1 281.6

Jacksonville, FL 761 1,027 1,149 1,258 1,225 135.6 178.7 195.6 209.9 204.4

Kansas City, MO-KS 729 984 1,671 2,010 1,970 80.0 106.5 179.0 212.7 208.5

Las Vegas-Paradise, NV 766 1,081 1,051 1,233 1,301 103.2 139.7 131.0 146.9 155.0

Los Angeles-Long Beach-Santa Ana, CA NA 12,001 13,161 13,208 14,585 NA 190.0 207.0 206.2 227.7

Louisville, KY-IN 509 546 626 572 909 89.3 95.0 108.0 97.8 155.3

Memphis, TN-MS-AR 1,179 1,123 1,712 2,111 2,307 201.3 189.7 286.6 350.1 382.6

Miami-Fort Lauderdale-Miami Beach, FL 1,790 2,220 1,997 2,171 1,911 72.1 87.6 77.9 83.5 73.5

Milwaukee-Waukesha-West Allis, WI NA 2,441 2,486 2,711 2,804 NA 332.5 337.7 367.7 380.3

Minneapolis-St. Paul-Bloomington, MN-WI NA 2,237 2,289 2,247 2,491 NA 148.2 150.0 145.5 161.3

Nashville-Davidson-Murfreesboro, TN 744 787 1,147 1,225 1,415 113.6 118.6 170.0 178.0 205.6

New Orleans-Metairie-Kenner, LA NA 1,317 1,355 1,327 1,100 NA 209.1 214.4 209.6 173.7

New York-Newark-Edison, NY-NJ-PA NA 8,086 10,437 11,125 15,890 NA 90.4 116.3 123.4 176.2

Oklahoma City, OK 757 925 823 882 1,054 139.2 167.9 147.7 156.2 186.6

Orlando, FL 757 802 821 895 1,195 90.1 92.8 92.3 97.3 129.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 5,465 6,628 6,915 6,677 NA 197.5 238.3 247.2 238.7

Phoenix-Mesa-Scottsdale, AZ NA NA 1,779 2,521 2,646 NA NA 98.2 134.6 141.3

Pittsburgh, PA NA 1,191 1,296 1,353 1,482 NA 102.9 112.3 117.6 128.8

Portland-Vancouver-Beaverton, OR-WA 1,315 1,327 1,371 1,701 1,820 133.8 132.4 135.0 165.4 177.0

Providence-New Bedford-Fall River, RI-MA NA 951 930 1,126 1,085 NA 122.6 118.9 143.3 138.1

Richmond, VA 694 852 1,045 1,348 1,281 129.2 156.5 189.6 240.7 228.8

Riverside-San Bernardino-Ontario, CA NA 2,248 2,563 2,654 2,913 NA 127.8 140.7 139.8 153.5

Rochester, NY NA 577 1,152 1,171 1,180 NA 113.8 227.6 230.9 232.7

Sacramento-Arden-Arcade-Roseville, CA NA 1,299 1,588 1,901 2,220 NA 137.0 163.5 191.7 223.9

Salt Lake City, UT 573 685 689 722 933 115.3 136.2 135.5 140.1 181.1

San Antonio, TX 1,159 1,193 1,225 1,460 1,942 135.6 136.6 137.4 160.9 214.0

San Diego-Carlsbad-San Marcos, CA NA 2,641 2,715 2,844 3,022 NA 180.7 184.0 192.9 205.0

San Francisco-Oakland-Fremont, CA NA 3,638 3,908 4,370 4,686 NA 176.2 189.9 212.4 227.8

San Jose-Sunnyvale-Santa Clara, CA NA 1,171 1,315 1,628 1,575 NA 132.9 149.2 183.9 177.9

Seattle-Tacoma-Bellevue, WA 2,371 2,551 2,851 2,880 3,177 153.7 163.8 182.0 182.2 201.0

St. Louis, MO-IL 1,324 1,807 1,902 2,770 3,524 101.2 137.4 144.1 207.4 263.8

Tampa-St. Petersburg-Clearwater, FL 866 1,184 1,156 1,076 1,131 73.3 98.3 94.3 85.7 90.1

Virginia Beach-Norfolk-Newport News, VA-NC 1,017 1,098 1,276 1,724 2,375 129.7 138.0 157.9 212.4 292.5

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 2,197 2,120 2,848 2,706 NA 89.7 85.4 113.5 107.8

U.S. MSA TOTAL 37,241 108,404 115,127 124,765 139,651 124.3 146.3 150.2 160.9 180.1

Table 8. Chlamydia — Men – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific case counts and

rates to be determined for some jurisdictions for some years.
98 Chlamydia Tables STD Surveillance 2005

Age

Group

Cases Rates

Year Total Male Female Total Male Female

2001

10-14 15,031 1,042 13,989 71.9 9.7 137.2

15-19 288,333 39,064 249,269 1,422.4 374.8 2,531.3

20-24 285,589 58,597 226,992 1,448.8 581.3 2,357.0

25-29 106,914 27,896 79,018 562.0 289.1 842.8

30-34 45,255 14,493 30,763 217.7 138.4 298.0

35-39 21,516 7,953 13,563 96.4 71.4 121.4

40-44 9,940 4,124 5,816 43.6 36.4 50.6

45-54 6,415 2,943 3,472 16.4 15.3 17.4

55-64 1,282 638 644 5.1 5.2 4.9

65+ 919 313 606 2.6 2.1 2.9

TOTAL 783,127 157,623 625,504 274.5 112.5 430.7

2002

10-14 15,294 1,076 14,218 72.4 9.9 137.9

15-19 299,863 42,433 257,429 1,471.6 405.2 2,599.0

20-24 305,400 66,991 238,408 1,510.9 647.3 2,417.1

25-29 116,422 32,497 83,925 613.7 337.1 899.3

30-34 50,339 16,847 33,492 240.2 159.5 322.2

35-39 23,411 9,298 14,113 106.8 84.9 128.8

40-44 11,405 5,122 6,283 49.6 44.9 54.2

45-54 7,644 3,652 3,992 19.1 18.6 19.6

55-64 1,451 746 705 5.5 5.8 5.1

65+ 812 296 516 2.3 2.0 2.5

TOTAL 834,503 180,039 654,464 289.4 127.1 446.1

2003

10-14 14,911 1,061 13,849 70.4 9.8 134.0

15-19 310,505 44,331 266,175 1,516.3 421.4 2,672.5

20-24 324,411 71,476 252,936 1,565.1 670.3 2,513.3

25-29 124,890 34,916 89,974 651.6 357.3 957.7

30-34 53,572 17,810 35,762 258.7 170.4 348.7

35-39 24,658 9,772 14,886 115.2 91.1 139.4

40-44 12,287 5,675 6,612 53.5 49.8 57.2

45-54 8,214 4,012 4,202 20.1 20.0 20.2

55-64 1,653 883 770 5.9 6.6 5.3

65+ 776 323 453 2.2 2.2 2.2

TOTAL 877,478 190,723 686,755 301.7 133.3 464.7

2004

10-14 14,817 1,172 13,646 70.1 10.8 132.3

15-19 323,246 48,209 275,036 1,559.3 453.3 2,724.6

20-24 344,159 79,410 264,749 1,641.1 735.1 2,603.7

25-29 137,041 39,374 97,667 700.6 393.9 1,021.0

30-34 56,759 19,353 37,406 277.3 187.1 369.3

35-39 26,486 10,647 15,839 125.8 100.7 151.1

40-44 13,626 6,397 7,229 59.1 55.8 62.4

45-54 9,251 4,602 4,649 22.2 22.5 22.0

55-64 1,885 993 892 6.5 7.1 5.9

65+ 755 335 420 2.1 2.2 2.0

TOTAL 929,462 210,935 718,527 316.5 145.9 481.9

2005

10-14 14,124 1,200 12,924 66.8 11.1 125.3

15-19 336,036 53,734 282,302 1,621.0 505.2 2,796.6

20-24 360,574 86,931 273,643 1,719.4 804.7 2,691.1

25-29 148,059 44,712 103,347 756.9 447.4 1,080.4

30-34 60,065 21,102 38,964 293.4 204.1 384.6

35-39 28,509 11,700 16,809 135.4 110.7 160.4

40-44 14,397 6,940 7,458 62.4 60.5 64.3

45-54 10,105 5,203 4,902 24.3 25.4 23.2

55-64 2,191 1,169 1,021 7.5 8.4 6.8

65+ 885 402 483 2.4 2.7 2.3

TOTAL 976,445 233,553 742,892 332.5 161.6 498.2

Table 9. Chlamydia — Reported cases and rates per 100,000 population by age group and sex: United

States, 2001–2005

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
This page intentionally left blank.
100 Chlamydia Tables STD Surveillance 2005

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2001

10-14 3,203 122 3,081 7,271 523 6,748 2,176 225 1,951 134 7 127 245 12 233

15-19 79,923 7,591 72,331 122,896 19,374 103,522 42,630 6,852 35,778 3,907 514 3,393 4,820 601 4,220

20-24 79,134 14,649 64,485 115,191 26,365 88,827 49,029 10,255 38,774 4,815 905 3,910 4,255 683 3,572

25-29 24,529 6,214 18,315 41,444 12,463 28,981 23,461 5,493 17,968 2,364 536 1,828 1,978 373 1,605

30-34 9,779 3,137 6,642 16,909 6,553 10,356 10,347 2,698 7,649 1,140 291 848 878 150 728

35-39 4,814 1,909 2,905 8,034 3,577 4,457 4,478 1,193 3,285 639 213 426 488 102 385

40-44 2,369 1,057 1,311 3,795 1,904 1,892 1,833 536 1,297 286 85 202 247 59 189

45-54 1,631 831 800 2,492 1,352 1,140 962 299 663 209 61 149 184 52 132

55-64 371 191 179 479 291 188 169 62 107 44 17 28 24 8 17

65+ 199 63 136 371 149 222 143 43 100 29 13 16 6 4 2

TOTAL 206,348 35,882 170,467 319,667 72,769 246,898 135,617 27,792 107,824 13,590 2,646 10,943 13,164 2,049 11,115

2002

10-14 3,349 94 3,255 8,245 665 7,580 2,308 234 2,074 160 6 153 291 13 278

15-19 87,116 8,455 78,660 138,051 22,908 115,143 48,145 7,609 40,536 3,927 479 3,448 5,158 698 4,461

20-24 91,120 17,951 73,169 130,338 31,430 98,908 56,493 12,380 44,113 5,821 1,137 4,684 5,089 847 4,242

25-29 29,455 7,780 21,674 47,920 15,117 32,803 27,621 6,808 20,813 2,922 709 2,213 2,175 434 1,741

30-34 11,867 3,978 7,889 20,437 8,111 12,326 12,636 3,259 9,377 1,621 446 1,176 1,067 214 853

35-39 5,723 2,500 3,223 9,450 4,329 5,121 5,554 1,611 3,943 833 224 610 574 146 428

40-44 2,892 1,422 1,469 4,821 2,503 2,319 2,350 740 1,609 446 114 332 332 89 243

45-54 2,129 1,165 964 3,142 1,690 1,452 1,404 435 970 384 130 253 198 57 141

55-64 410 282 128 580 309 271 269 88 182 82 23 59 36 10 26

65+ 226 68 158 376 166 210 141 37 104 20 7 13 10 4 7

TOTAL 234,839 43,913 190,925 364,513 87,744 276,769 157,458 33,453 124,005 16,276 3,300 12,976 14,981 2,538 12,444

2003

10-14 3,336 116 3,219 8,320 721 7,600 2,210 166 2,044 145 7 139 302 19 283

15-19 93,457 8,820 84,637 147,549 25,606 121,944 48,899 7,407 41,493 4,071 445 3,627 5,517 815 4,702

20-24 103,138 20,467 82,671 138,950 34,080 104,871 58,996 12,572 46,424 6,046 1,156 4,890 5,428 1,001 4,427

25-29 33,634 9,219 24,415 52,640 16,408 36,232 28,313 6,876 21,437 3,120 810 2,310 2,385 477 1,908

30-34 13,149 4,309 8,839 22,401 8,645 13,756 13,001 3,502 9,499 1,830 493 1,337 1,066 238 828

35-39 6,091 2,586 3,505 10,340 4,799 5,541 5,728 1,644 4,084 876 252 624 630 158 472

40-44 3,331 1,689 1,642 5,339 2,859 2,480 2,355 733 1,622 434 124 310 339 75 264

45-54 2,420 1,347 1,073 3,440 1,879 1,561 1,418 454 964 378 131 247 210 55 155

55-64 524 326 198 635 361 273 293 113 180 89 33 56 51 15 36

65+ 277 112 165 301 144 158 130 37 93 22 14 8 17 3 14

TOTAL 259,808 49,115 210,693 390,660 95,741 294,918 161,629 33,576 128,053 17,042 3,469 13,573 15,964 2,859 13,105

2004

10-14 3,199 122 3,076 8,504 759 7,745 2,152 222 1,929 135 5 130 266 31 236

15-19 95,195 9,468 85,727 157,398 28,143 129,255 49,457 7,769 41,688 3,900 485 3,415 5,551 776 4,774

20-24 109,590 22,268 87,322 149,743 38,420 111,322 59,885 13,482 46,403 6,232 1,291 4,941 5,820 1,176 4,644

25-29 37,871 10,560 27,311 58,590 18,657 39,933 29,424 7,409 22,014 3,159 802 2,357 2,614 549 2,065

30-34 13,869 4,596 9,273 24,171 9,671 14,499 13,326 3,572 9,754 1,863 502 1,361 1,209 287 922

35-39 6,553 2,748 3,806 11,323 5,277 6,047 5,927 1,777 4,150 967 324 643 646 161 486

40-44 3,815 1,947 1,868 5,900 3,148 2,753 2,532 829 1,703 499 164 335 332 90 242

45-54 2,543 1,360 1,182 4,190 2,322 1,868 1,416 501 915 471 178 294 265 82 183

55-64 593 363 231 790 444 346 292 118 174 88 26 62 40 8 33

65+ 253 116 137 281 140 140 118 37 81 27 9 17 19 7 12

TOTAL 273,854 53,669 220,186 421,608 107,202 314,407 164,762 35,786 128,976 17,358 3,791 13,568 16,787 3,174 13,613

2005

10-14 2,986 126 2,860 7,355 723 6,631 2,069 183 1,886 112 14 98 332 24 309

15-19 93,876 9,636 84,240 153,777 30,214 123,563 52,224 8,526 43,698 3,761 646 3,115 5,964 882 5,082

20-24 114,066 24,303 89,763 142,156 39,355 102,801 64,259 14,772 49,487 6,315 1,416 4,899 6,148 1,295 4,853

25-29 40,477 11,580 28,897 57,704 19,824 37,879 31,795 8,528 23,267 3,107 896 2,211 2,829 715 2,114

30-34 14,600 4,739 9,861 23,142 9,740 13,402 14,349 4,132 10,217 1,849 638 1,211 1,177 270 906

35-39 7,143 3,024 4,119 10,768 5,300 5,468 6,539 2,001 4,538 1,057 337 720 625 181 444

40-44 3,986 2,045 1,941 5,662 3,148 2,515 2,656 908 1,748 559 213 346 345 92 254

45-54 2,875 1,639 1,236 4,032 2,338 1,693 1,674 575 1,100 443 158 286 240 82 158

55-64 657 408 250 791 467 324 334 123 211 148 47 101 50 21 30

65+ 253 123 130 345 168 177 141 53 87 35 18 17 15 4 12

TOTAL 281,268 57,709 223,559 406,423 111,513 294,910 176,271 39,885 136,386 17,408 4,388 13,020 17,762 3,571 14,191

Table 10A. Chlamydia — Reported cases by race/ethnicity, age group and sex: United States, 2001–2005

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 9 for age-specific cases and rates and Tables 3-5 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded: 2001 (CO, DC, MD, NJ, NY); 2002 (MI, NJ); 2003 (CO, DC, NJ); 2004 (CO, DC, NJ); 2005; (CO, DC, GA, HI, NJ). Differences

between total cases from this table and others in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is

not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2005 Chlamydia Tables 101

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10-14 27.6 2.1 54.6 264.2 37.5 497.8 74.1 14.9 136.2 19.4 1.9 37.8 110.4 10.6 213.5

2001

15-19 693.7 128.4 1,289.5 4,870.0 1,510.8 8,340.6 1,544.1 471.6 2,735.5 546.9 141.2 967.9 2,270.1 554.2 4,058.5

20-24 725.0 265.4 1,195.0 4,938.4 2,304.2 7,474.9 1,603.7 604.8 2,847.8 617.6 233.2 998.6 2,379.7 753.8 4,048.7

25-29 239.2 120.0 360.7 1,983.4 1,245.4 2,661.9 754.2 323.1 1,274.0 260.6 120.9 394.1 1,258.6 472.3 2,052.7

30-34 83.0 52.9 113.6 782.2 638.3 912.4 359.5 174.5 574.4 124.0 65.1 179.8 550.8 188.7 909.7

35-39 36.2 28.6 43.8 351.1 331.2 368.9 175.1 88.3 272.1 75.1 51.7 97.1 281.0 120.3 435.3

40-44 16.5 14.8 18.3 166.8 177.7 157.0 86.6 49.0 126.7 36.6 23.0 48.8 142.2 70.3 208.7

45-54 6.3 6.5 6.1 70.1 81.7 60.0 33.4 20.8 46.2 16.0 10.1 21.0 65.5 38.4 90.7

55-64 2.1 2.3 2.0 24.3 32.9 17.4 11.1 8.6 13.3 6.0 4.9 7.0 15.2 9.9 20.1

65+ 0.8 0.6 0.9 15.8 16.5 15.4 9.1 6.4 11.1 3.7 3.9 3.4 4.2 6.1 2.7

TOTAL 118.7 42.1 192.4 1,083.9 516.8 1,602.2 423.8 167.9 698.2 138.3 55.8 215.0 587.8 185.6 978.7

10-14 27.4 1.5 54.7 266.2 42.3 496.7 67.9 13.5 125.0 20.2 1.6 39.7 128.8 11.3 249.7

2002

15-19 715.7 135.2 1,329.6 4,887.6 1,595.0 8,294.0 1,566.1 475.4 2,751.1 489.7 117.4 875.6 2,356.2 624.1 4,164.2

20-24 772.3 300.6 1,255.8 4,847.2 2,371.6 7,252.9 1,626.9 645.4 2,838.4 647.3 255.0 1,033.5 2,665.7 874.5 4,512.4

25-29 274.7 144.0 407.6 2,066.4 1,365.9 2,706.0 765.5 343.7 1,278.6 281.0 141.1 411.8 1,346.7 534.8 2,167.7

30-34 95.4 63.5 127.7 831.5 697.2 952.2 368.7 177.3 590.3 144.0 81.7 202.5 647.3 260.2 1,032.3

35-39 41.9 36.5 47.3 367.6 358.1 376.1 184.3 101.5 276.4 81.9 45.4 116.3 329.7 171.2 482.5

40-44 19.0 18.7 19.3 185.2 205.0 167.6 92.7 56.7 131.0 47.6 25.6 67.6 183.8 102.2 259.6

45-54 7.6 8.4 6.9 75.3 87.7 64.7 40.2 24.9 55.4 24.4 17.9 30.0 66.5 39.6 91.2

55-64 2.1 3.0 1.3 24.5 29.4 20.6 14.3 9.8 18.3 9.0 5.4 12.1 20.5 11.6 28.7

65+ 0.8 0.6 1.0 13.9 16.1 12.6 7.5 4.6 9.6 2.2 1.8 2.4 6.6 5.6 7.4

TOTAL 126.9 48.4 202.2 1,087.8 550.3 1,575.9 423.4 174.3 688.8 140.4 59.1 216.0 644.8 221.6 1,056.2

10-14 26.8 1.8 53.1 257.1 43.8 477.2 63.5 9.3 120.3 18.1 1.6 35.6 132.8 16.1 252.4

2003

15-19 747.8 137.3 1,393.3 5,004.5 1,711.0 8,399.4 1,586.1 463.0 2,797.2 502.0 106.7 919.6 2,472.4 717.0 4,295.6

20-24 836.7 327.1 1,362.2 4,926.4 2,426.8 7,405.0 1,662.2 640.1 2,928.8 641.0 243.0 1,046.1 2,692.8 977.9 4,462.0

25-29 305.2 165.7 447.3 2,176.4 1,414.5 2,878.6 788.7 347.7 1,329.4 293.1 154.6 427.0 1,440.8 573.2 2,318.3

30-34 105.8 68.9 143.3 888.2 723.6 1,036.4 384.8 192.9 607.5 155.2 85.5 222.0 642.5 288.1 995.1

35-39 45.0 38.1 52.0 400.5 395.1 405.2 191.4 103.6 290.4 84.2 49.7 116.9 369.1 188.7 543.4

40-44 21.6 22.0 21.3 199.9 228.9 174.4 91.2 54.8 130.3 44.7 26.5 61.6 185.1 84.6 279.1

45-54 8.4 9.4 7.4 77.8 92.0 65.6 39.4 25.2 53.6 23.0 17.2 28.1 67.8 37.3 95.8

55-64 2.5 3.2 1.8 25.0 31.9 19.4 14.9 12.2 17.4 9.0 7.2 10.6 27.4 16.9 37.0

65+ 1.0 0.9 1.0 10.8 13.4 9.1 6.7 4.5 8.3 2.2 3.2 1.4 10.6 4.9 14.9

TOTAL 136.7 52.7 217.4 1,122.3 577.4 1,617.9 428.2 172.3 701.5 141.6 59.4 219.1 672.2 244.4 1,087.2

10-14 26.0 1.9 51.5 263.3 46.3 487.3 59.8 12.1 109.8 16.6 1.2 32.9 119.7 27.2 214.2

2004

15-19 757.4 146.7 1,402.3 5,217.4 1,840.6 8,687.4 1,562.2 474.9 2,725.0 475.0 114.9 856.3 2,467.3 677.8 4,323.7

20-24 878.2 350.5 1,425.4 5,215.0 2,673.0 7,762.9 1,677.8 686.3 2,891.6 658.5 269.6 1,056.5 2,790.5 1,113.2 4,512.3

25-29 337.6 186.4 491.8 2,351.1 1,553.3 3,093.3 794.8 361.4 1,332.5 294.5 152.1 432.4 1,541.8 641.3 2,459.7

30-34 114.9 75.6 154.7 963.4 813.6 1,098.2 381.1 189.7 604.4 153.2 84.3 219.2 734.2 350.3 1,115.4

35-39 49.9 41.7 58.2 447.4 442.3 452.0 191.9 108.1 287.2 89.7 61.7 116.4 389.7 196.4 578.0

40-44 24.9 25.5 24.4 219.1 249.9 192.0 93.0 58.5 130.3 49.4 33.7 64.1 180.0 100.9 254.4

45-54 8.7 9.4 8.0 92.2 110.6 76.4 37.3 26.3 48.4 27.7 22.3 32.4 83.8 54.0 111.0

55-64 2.7 3.4 2.1 29.6 37.3 23.4 14.0 11.8 15.9 8.3 5.2 11.0 20.5 8.0 31.9

65+ 0.9 1.0 0.8 9.9 12.9 8.0 5.8 4.3 6.8 2.5 2.1 2.9 11.1 9.9 11.9

TOTAL 143.6 57.4 226.7 1,196.6 638.4 1,704.8 421.4 177.1 682.4 139.8 62.9 212.3 699.9 268.8 1,117.9

10-14 25.1 2.1 49.3 246.0 47.6 450.9 58.4 10.1 108.9 15.0 3.6 27.1 150.6 21.1 283.0

2005

15-19 769.6 153.9 1,419.4 5,502.6 2,132.1 8,969.7 1,674.9 529.8 2,896.0 499.9 167.0 852.1 2,675.3 777.7 4,641.7

20-24 942.7 394.9 1,509.8 5,360.0 2,965.5 7,758.2 1,839.7 771.0 3,138.1 718.4 318.8 1,126.2 2,979.8 1,240.1 4,763.3

25-29 373.0 211.4 537.8 2,524.0 1,798.3 3,199.9 880.1 427.9 1,436.5 309.4 181.8 432.4 1,688.6 846.4 2,546.0

30-34 125.3 80.8 170.4 1,008.3 895.0 1,110.5 419.7 225.2 645.1 162.3 114.6 208.1 723.5 334.0 1,109.9

35-39 56.2 47.4 65.1 463.6 483.6 445.7 215.9 124.5 319.3 105.6 69.1 140.3 381.7 224.3 535.0

40-44 26.9 27.6 26.1 227.9 270.7 190.2 99.2 65.3 135.7 60.2 47.6 71.9 189.9 104.0 270.6

45-54 10.1 11.6 8.6 95.7 120.1 74.7 44.7 30.6 58.9 28.5 21.7 34.4 77.0 55.2 96.9

55-64 3.1 4.0 2.3 31.7 42.0 23.5 16.2 12.6 19.4 15.5 10.7 19.7 25.9 22.1 29.4

65+ 0.9 1.1 0.8 12.9 16.4 10.7 6.9 6.2 7.5 3.8 4.7 3.2 9.1 5.0 12.3

TOTAL 152.1 63.6 237.2 1,247.0 717.8 1,729.0 459.0 201.4 733.2 152.9 79.3 222.3 748.7 305.9 1,177.7

Table 10B. Chlamydia — Rates per 100,000 population by race/ethnicity, age group and sex: United States,

2001–2005

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 9 for age-specific cases and rates and Tables 3-5 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were

specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded: 2001 (CO, DC, MD, NJ, NY); 2002 (MI, NJ); 2003 (CO, DC, NJ); 2004 (CO, DC, NJ); 2005 (CO, DC, GA, HI, NJ). Differences between total rates from this table and others in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is not shown because some of these cases

may not be due to sexual transmission; however, they are included in the totals.
102 Gonorrhea Tables STD Surveillance 2005

Rank* State/Area Cases Rate per 100,000 Population

1 Mississippi 7,171 247.0

2 Louisiana 9,572 212.0

3 Alabama 9,406 207.6

4 South Carolina 8,561 203.9

5 Ohio 20,985 183.1

6 Georgia 15,860 179.6

7 North Carolina 15,072 176.5

8 Michigan 17,684 174.9

9 Missouri 9,455 164.3

10 Arkansas 4,476 162.6

11 Illinois 20,019 157.5

12 Oklahoma 5,228 148.4

13 Tennessee 8,605 145.8

14 Indiana 8,094 129.8

15 Maryland 7,035 126.6

16 Nevada 2,880 123.4

17 Florida 20,225 116.3

18 Texas 26,110 116.1

U.S. TOTAL† 339,593 115.6

19 Virginia 8,346 111.9

20 Delaware 913 110.0

21 Wisconsin 5,869 106.5

22 California 34,338 95.7

23 Kansas 2,605 95.2

24 New York 17,717 92.1

25 Alaska 600 91.5

26 Pennsylvania 11,222 90.5

27 Arizona 4,951 86.2

28 New Mexico 1,552 81.5

29 Hawaii 1,024 81.1

30 Connecticut 2,750 78.5

31 Kentucky 2,935 70.8

32 Colorado 3,224 70.1

33 Minnesota 3,482 68.3

34 Nebraska 1,158 66.3

35 New Jersey 5,722 65.8

36 Washington 3,739 60.3

37 Iowa 1,606 54.4

38 South Dakota 351 45.5

39 Oregon 1,562 43.5

40 West Virginia 770 42.4

41 Rhode Island 438 40.5

42 Massachusetts 2,537 39.5

43 Utah 727 30.4

44 North Dakota 128 20.2

YEAR 2010 TARGET 19.0

45 Wyoming 87 17.2

46 Montana 158 17.0

47 New Hampshire 177 13.6

48 Maine 142 10.8

49 Vermont 60 9.7

50 Idaho 119 8.5

Table 11. Gonorrhea — Reported cases and rates by state/area, ranked by rates: United States, 2005

*States were ranked in descending order by rate, number of cases, and alphabetically by state.

†

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 106 cases and rate of 63.8, Puerto Rico with 328 cases

and rate of 8.4, and Virgin Islands with 30 cases and rate of 27.6).
STD Surveillance 2005 Gonorrhea Tables 103

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 11,182 10,118 9,303 8,206 9,406 250.2 225.5 206.7 181.1 207.6

Alaska 457 641 573 567 600 72.1 99.6 88.3 86.5 91.5

Arizona 3,920 3,795 3,580 4,065 4,951 73.9 69.6 64.1 70.8 86.2

Arkansas 4,604 4,584 4,251 4,137 4,476 170.9 169.1 156.0 150.3 162.6

California 23,296 24,606 25,963 30,155 34,338 67.3 70.1 73.2 84.0 95.7

Colorado 3,190 3,511 2,854 3,054 3,224 72.0 77.9 62.7 66.4 70.1

Connecticut 2,546 3,241 3,114 2,862 2,750 74.1 93.7 89.4 81.7 78.5

Delaware 1,733 1,576 1,128 894 913 217.5 195.2 138.0 107.7 110.0

Florida 21,531 21,348 18,974 18,580 20,225 131.5 127.7 111.5 106.8 116.3

Georgia 18,920 18,383 17,686 15,783 15,860 225.1 214.7 203.6 178.8 179.6

Hawaii 604 740 1,263 1,193 1,024 49.2 59.4 100.4 94.5 81.1

Idaho 76 94 68 103 119 5.8 7.0 5.0 7.4 8.5

Illinois 24,025 24,026 21,817 20,597 20,019 191.9 190.7 172.4 162.0 157.5

Indiana 6,972 7,395 6,681 6,851 8,094 113.8 120.1 107.8 109.8 129.8

Iowa 1,418 1,480 1,554 1,249 1,606 48.4 50.4 52.8 42.3 54.4

Kansas 2,669 2,744 2,647 2,542 2,605 98.8 101.0 97.2 92.9 95.2

Kentucky 3,588 3,772 3,578 2,758 2,935 88.2 92.2 86.9 66.5 70.8

Louisiana 12,253 11,387 11,850 10,538 9,572 274.1 254.0 263.5 233.4 212.0

Maine 141 142 233 210 142 11.0 11.0 17.8 15.9 10.8

Maryland 9,427 9,355 8,032 8,297 7,035 175.0 171.4 145.8 149.3 126.6

Massachusetts 3,214 3,242 2,901 3,057 2,537 50.2 50.4 45.1 47.6 39.5

Michigan 17,120 14,770 13,965 17,376 17,684 171.1 147.0 138.5 171.8 174.9

Minnesota 2,701 3,049 3,202 2,957 3,482 54.2 60.7 63.3 58.0 68.3

Mississippi 7,759 6,875 6,328 7,163 7,171 271.3 239.4 219.6 246.7 247.0

Missouri 8,723 8,952 8,792 9,218 9,455 154.7 157.8 154.1 160.2 164.3

Montana 104 123 122 88 158 11.5 13.5 13.3 9.5 17.0

Nebraska 1,189 1,564 1,623 1,147 1,158 69.1 90.4 93.3 65.6 66.3

Nevada 1,756 1,988 2,221 3,078 2,880 83.7 91.5 99.1 131.8 123.4

New Hampshire 176 120 125 133 177 14.0 9.4 9.7 10.2 13.6

New Jersey 8,921 7,894 7,944 6,696 5,722 104.8 91.9 92.0 77.0 65.8

New Mexico 1,040 1,462 1,169 1,306 1,552 56.8 78.8 62.4 68.6 81.5

New York 22,299 21,841 22,166 18,737 17,717 116.8 114.0 115.5 97.5 92.1

North Carolina 16,583 15,531 15,116 15,194 15,072 202.1 186.7 179.8 177.9 176.5

North Dakota 56 72 103 110 128 8.8 11.4 16.3 17.3 20.2

Ohio 21,163 22,008 22,537 20,467 20,985 185.8 192.7 197.1 178.6 183.1

Oklahoma 4,784 4,661 4,552 4,453 5,228 137.9 133.4 129.6 126.4 148.4

Oregon 1,144 909 1,000 1,302 1,562 32.9 25.8 28.1 36.2 43.5

Pennsylvania 14,244 13,294 11,866 11,236 11,222 115.8 107.8 96.0 90.6 90.5

Rhode Island 830 900 973 816 438 78.3 84.1 90.4 75.5 40.5

South Carolina 10,805 9,152 8,518 9,171 8,561 266.0 222.8 205.4 218.5 203.9

South Dakota 289 263 226 304 351 38.1 34.6 29.6 39.4 45.5

Tennessee 10,145 9,348 8,519 8,475 8,605 176.5 161.2 145.8 143.6 145.8

Texas 30,024 26,988 24,595 24,371 26,110 140.5 123.9 111.2 108.4 116.1

Utah 219 374 412 603 727 9.6 16.1 17.5 25.2 30.4

Vermont 76 98 97 86 60 12.4 15.9 15.7 13.8 9.7

Virginia 11,095 10,462 9,066 8,565 8,346 154.2 143.4 122.7 114.8 111.9

Washington 2,991 2,925 2,753 2,810 3,739 49.9 48.2 44.9 45.3 60.3

West Virginia 732 974 847 892 770 40.6 54.1 46.8 49.1 42.4

Wisconsin 6,011 6,341 5,663 5,053 5,869 111.2 116.5 103.5 91.7 106.5

Wyoming 77 65 46 59 87 15.6 13.0 9.2 11.6 17.2

U.S. TOTAL* 361,705 351,852 335,104 330,132 339,593 126.8 122.0 115.2 112.4 115.6

Northeast 52,447 50,772 49,419 43,833 40,765 97.2 93.6 90.8 80.3 74.7

Midwest 92,336 92,664 88,810 87,871 91,436 142.5 142.2 135.8 133.7 139.1

South 178,048 167,183 154,851 150,045 152,431 174.6 161.8 148.1 141.6 143.9

West 38,874 41,233 42,024 48,383 54,961 60.2 62.8 63.2 71.8 81.5

Guam 48 49 65 114 106 30.3 30.4 39.7 68.6 63.8

Puerto Rico 589 411 276 267 328 15.3 10.6 7.1 6.9 8.4

Virgin Islands 34 49 91 75 30 31.1 44.5 83.6 68.9 27.6

OUTLYING AREAS 671 509 432 456 464 16.3 12.3 10.4 10.9 11.1

TOTAL 362,376 352,361 335,536 330,588 340,057 125.2 120.5 113.8 111.0 114.2

Table 12. Gonorrhea — Reported cases and rates by state/area and region listed in alphabetical order: United

States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.
104 Gonorrhea Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 5,712 4,974 4,583 3,673 4,494 247.3 214.6 197.4 157.4 192.5

Alaska 244 353 339 337 349 79.7 113.6 108.1 106.5 110.3

Arizona 1,700 1,659 1,636 1,787 2,338 64.0 60.8 58.7 62.3 81.5

Arkansas 2,404 2,388 2,108 2,032 2,252 174.4 172.4 151.5 144.7 160.4

California 10,448 10,857 11,912 13,620 15,827 60.2 61.7 67.0 75.8 88.0

Colorado 1,588 1,643 1,529 1,656 1,619 72.2 73.5 67.8 72.6 71.0

Connecticut 1,411 1,910 1,910 1,756 1,590 79.7 107.2 106.6 97.4 88.2

Delaware 1,002 858 602 508 515 244.6 206.7 143.5 119.3 121.0

Florida 10,380 10,373 9,419 9,371 10,204 123.9 121.4 108.5 105.6 115.0

Georgia 9,590 9,306 9,137 8,119 7,819 224.8 214.3 207.8 181.9 175.2

Hawaii 292 394 723 680 619 47.7 63.5 115.3 107.5 97.8

Idaho 39 49 18 42 57 5.9 7.3 2.6 6.0 8.2

Illinois 12,178 12,273 11,624 11,510 10,998 190.7 191.1 180.4 177.9 170.0

Indiana 3,792 3,996 3,610 3,550 4,453 121.6 127.5 114.6 112.0 140.5

Iowa 766 821 869 736 885 51.3 54.9 58.1 49.1 59.0

Kansas 1,468 1,556 1,522 1,565 1,645 107.5 113.4 110.8 113.6 119.5

Kentucky 1,812 1,936 1,845 1,415 1,530 87.2 92.6 87.8 67.0 72.4

Louisiana 6,056 5,861 6,076 5,450 4,761 262.7 253.7 262.6 234.7 205.1

Maine 55 44 84 84 61 8.3 6.6 12.6 12.5 9.0

Maryland 4,591 4,592 4,166 4,327 3,620 164.9 162.9 146.5 150.9 126.3

Massachusetts 1,591 1,579 1,342 1,531 1,320 48.0 47.5 40.4 46.3 39.9

Michigan 9,057 7,974 7,823 9,614 10,161 177.7 155.9 152.5 186.9 197.5

Minnesota 1,461 1,688 1,784 1,712 1,909 58.1 66.7 70.0 66.6 74.3

Mississippi 4,663 4,201 3,757 4,362 4,234 315.6 283.3 253.0 291.9 283.4

Missouri 4,540 4,810 4,794 5,139 5,334 156.8 165.2 164.1 174.6 181.2

Montana 57 75 74 54 102 12.5 16.4 16.1 11.6 22.0

Nebraska 671 909 924 656 688 77.0 103.8 105.0 74.2 77.9

Nevada 761 965 1,062 1,417 1,343 73.9 90.5 96.6 123.7 117.2

New Hampshire 96 51 57 54 97 15.0 7.9 8.7 8.2 14.7

New Jersey 4,522 3,958 4,550 3,607 3,077 103.3 89.6 102.6 80.8 68.9

New Mexico 472 740 598 749 884 50.7 78.5 62.8 77.4 91.4

New York 11,873 11,141 11,296 9,720 9,031 120.2 112.5 113.9 98.0 91.0

North Carolina 7,810 7,585 7,383 7,384 7,545 186.7 178.9 172.6 170.0 173.8

North Dakota 30 40 59 72 76 9.4 12.6 18.6 22.7 23.9

Ohio 11,257 11,944 12,390 11,144 11,592 192.2 203.5 211.1 189.6 197.2

Oklahoma 2,670 2,566 2,562 2,471 3,018 151.5 144.7 143.9 138.6 169.2

Oregon 448 357 389 567 661 25.6 20.1 21.7 31.4 36.6

Pennsylvania 7,872 7,200 6,644 6,295 6,271 123.8 113.0 104.2 98.5 98.1

Rhode Island 488 484 517 478 227 88.7 87.2 92.7 85.4 40.6

South Carolina 5,126 4,357 4,369 5,007 4,601 245.5 206.3 205.3 232.6 213.7

South Dakota 166 148 133 178 196 43.5 38.6 34.6 45.9 50.6

Tennessee 4,808 4,564 4,263 4,327 4,395 163.1 153.6 142.6 143.5 145.8

Texas 15,599 14,075 12,643 12,433 13,827 145.1 128.5 113.8 110.1 122.5

Utah 95 150 153 266 319 8.4 13.0 13.1 22.4 26.8

Vermont 42 56 48 53 26 13.4 17.8 15.2 16.8 8.2

Virginia 5,485 5,445 4,809 4,650 4,402 149.6 146.7 128.1 122.7 116.2

Washington 1,301 1,197 1,167 1,229 1,622 43.2 39.3 38.0 39.5 52.2

West Virginia 418 567 464 470 427 45.2 61.3 50.0 50.6 46.0

Wisconsin 3,672 3,717 3,299 2,953 3,433 134.3 135.1 119.3 106.1 123.4

Wyoming 43 38 28 39 54 17.5 15.3 11.2 15.5 21.5

U.S. TOTAL* 183,863 179,648 174,230 172,142 177,537 126.6 122.5 117.9 115.4 119.1

Northeast 27,950 26,423 26,448 23,578 21,700 100.3 94.4 94.3 83.9 77.2

Midwest 49,058 49,876 48,831 48,829 51,370 148.5 150.3 146.7 146.1 153.7

South 89,367 84,872 79,323 77,292 78,673 171.8 161.1 149.0 143.4 146.0

West 17,488 18,477 19,628 22,443 25,794 54.1 56.2 59.1 66.6 76.5

Guam 22 26 39 70 71 28.4 33.0 48.7 86.0 87.2

Puerto Rico 279 230 121 150 194 14.0 11.5 6.0 7.4 9.6

Virgin Islands 20 38 65 48 18 34.4 64.2 114.3 84.4 31.7

OUTLYING AREAS 321 294 225 268 283 15.1 13.7 10.5 12.4 13.1

TOTAL 184,184 179,942 174,455 172,410 177,820 125.0 120.9 116.4 114.0 117.5

Table 13. Gonorrhea — Women – Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2005 Gonorrhea Tables 105

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 5,457 5,131 4,705 4,526 4,892 252.7 236.5 215.9 206.1 222.7

Alaska 213 288 234 230 251 65.0 86.5 69.8 67.9 74.1

Arizona 2,220 2,136 1,942 2,274 2,610 83.8 78.4 69.6 79.1 90.8

Arkansas 2,191 2,194 2,141 2,104 2,223 166.5 165.6 160.5 156.0 164.8

California 12,701 13,586 13,965 16,440 18,348 73.6 77.6 78.8 91.8 102.4

Colorado 1,602 1,868 1,325 1,398 1,605 71.8 82.3 57.7 60.2 69.1

Connecticut 1,132 1,331 1,204 1,106 1,160 68.0 79.3 71.2 65.1 68.2

Delaware 731 718 526 386 398 188.9 183.0 132.1 95.4 98.4

Florida 11,149 10,975 9,555 9,209 10,021 139.4 134.3 114.6 108.0 117.6

Georgia 9,325 9,013 8,487 7,596 7,885 225.3 213.7 198.0 174.0 180.6

Hawaii 312 346 540 513 405 50.7 55.4 85.6 81.4 64.3

Idaho 35 45 50 60 60 5.3 6.7 7.3 8.6 8.6

Illinois 11,845 11,750 10,192 9,087 9,020 193.1 190.2 164.1 145.5 144.5

Indiana 3,169 3,372 3,040 3,270 3,616 105.4 111.5 99.8 106.6 117.8

Iowa 652 658 680 511 721 45.3 45.6 47.0 35.1 49.6

Kansas 1,201 1,188 1,125 977 960 89.9 88.4 83.3 71.9 70.7

Kentucky 1,769 1,834 1,727 1,338 1,399 88.9 91.6 85.6 65.8 68.8

Louisiana 6,197 5,466 5,710 5,029 4,744 286.2 251.6 261.6 229.2 216.2

Maine 86 98 149 126 81 13.8 15.6 23.4 19.6 12.6

Maryland 4,836 4,756 3,858 3,969 3,410 185.8 180.2 144.7 147.5 126.7

Massachusetts 1,622 1,663 1,552 1,524 1,216 52.5 53.6 49.9 49.1 39.1

Michigan 8,063 6,796 6,141 7,762 7,468 164.2 137.7 124.0 156.2 150.3

Minnesota 1,240 1,361 1,418 1,245 1,573 50.2 54.7 56.5 49.2 62.1

Mississippi 3,096 2,674 2,571 2,801 2,937 224.0 192.5 184.1 198.8 208.5

Missouri 4,183 4,142 3,998 4,079 4,121 152.5 150.0 143.7 145.1 146.6

Montana 47 47 47 33 56 10.4 10.4 10.3 7.1 12.1

Nebraska 516 653 695 488 467 60.8 76.5 80.9 56.5 54.1

Nevada 993 1,022 1,158 1,658 1,535 92.9 92.3 101.4 139.5 129.1

New Hampshire 80 69 68 79 80 12.9 11.0 10.7 12.3 12.5

New Jersey 4,391 3,930 3,389 3,089 2,645 106.2 94.2 80.6 72.9 62.4

New Mexico 555 716 567 557 668 61.7 78.5 61.5 59.5 71.4

New York 10,397 10,688 10,813 8,985 8,680 112.9 115.5 116.6 96.6 93.3

North Carolina 8,772 7,942 7,733 7,810 7,527 218.1 194.6 187.2 186.0 179.3

North Dakota 26 32 44 38 52 8.2 10.1 13.9 12.0 16.4

Ohio 9,679 9,819 9,856 9,046 9,035 174.9 176.8 177.1 162.1 161.9

Oklahoma 2,114 2,095 1,990 1,982 2,210 123.8 121.8 114.9 113.9 127.0

Oregon 696 552 611 735 901 40.4 31.6 34.5 41.1 50.4

Pennsylvania 6,372 6,094 5,214 4,941 4,950 107.2 102.1 87.1 82.2 82.3

Rhode Island 342 416 456 338 211 67.1 80.8 88.0 64.8 40.5

South Carolina 5,640 4,766 4,118 4,136 3,925 285.7 238.9 204.0 202.2 191.9

South Dakota 123 115 93 126 155 32.7 30.4 24.5 32.9 40.4

Tennessee 5,337 4,784 4,256 4,148 4,209 190.5 169.3 149.2 143.7 145.8

Texas 14,370 12,884 11,932 11,902 12,269 135.3 119.0 108.4 106.3 109.5

Utah 124 223 259 337 408 10.9 19.2 21.9 28.1 34.0

Vermont 34 42 49 33 34 11.3 13.9 16.1 10.8 11.1

Virginia 5,574 5,017 4,237 3,904 3,939 157.9 140.1 116.7 106.3 107.3

Washington 1,690 1,728 1,586 1,581 2,117 56.6 57.2 51.9 51.1 68.4

West Virginia 313 406 380 421 343 35.7 46.3 43.0 47.4 38.7

Wisconsin 2,321 2,612 2,341 2,087 2,431 86.9 97.1 86.5 76.5 89.1

Wyoming 34 27 18 20 33 13.7 10.8 7.1 7.8 12.9

U.S. TOTAL* 177,194 171,504 160,106 157,303 161,117 126.5 121.1 111.9 108.8 111.5

Northeast 24,456 24,331 22,894 20,221 19,057 93.7 92.7 86.8 76.4 72.0

Midwest 43,018 42,498 39,623 38,716 39,619 135.3 133.0 123.3 119.8 122.6

South 88,498 82,091 75,287 72,530 73,444 177.2 162.1 146.7 139.3 141.1

West 21,222 22,584 22,302 25,836 28,997 65.8 68.9 67.1 76.7 86.0

Guam 26 23 26 44 35 32.1 28.0 31.1 51.9 41.3

Puerto Rico 310 181 155 117 134 16.8 9.7 8.3 6.3 7.2

Virgin Islands 14 11 26 27 12 27.3 21.6 50.0 52.0 23.1

OUTLYING AREAS 350 215 207 188 181 17.7 10.8 10.3 9.4 9.0

TOTAL 177,544 171,719 160,313 157,491 161,298 125.0 119.5 110.5 107.5 110.1

Table 14. Gonorrhea — Men – Reported cases and rates by state/area and region listed in alphabetical order:

United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.

NOTE: Cases reported with unknown sex are not included in this table.
106 Gonorrhea Tables STD Surveillance 2005

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Cook County, IL 12,296 230.8 3

2 Los Angeles County, CA 11,307 113.8 6

3 Wayne County, MI 9,225 457.5 9

4 Philadelphia County, PA 5,053 343.7 11

5 Dallas County, TX 5,034 219.4 12

6 Harris County, TX 4,402 120.8 13

7 Cuyahoga County, OH 4,214 311.9 15

8 Marion County, IN 3,965 459.1 16

9 Milwaukee County, WI 3,953 426.0 17

10 Kings County, NY 3,772 152.4 18

11 Baltimore (City), MD 3,476 546.3 19

12 Shelby County, TN 3,227 355.3 20

13 Franklin County, OH 3,168 290.9 21

14 Hamilton County, OH 3,036 372.7 22

15 Maricopa County, AZ 2,917 83.3 23

16 San Diego County, CA 2,695 91.9 24

17 Jackson County, MO 2,659 402.8 24

18 St Louis (City), MO 2,653 772.8 25

19 Fulton County, GA 2,621 321.8 26

20 Tarrant County, TX 2,533 159.5 27

21 Clark County, NV 2,487 150.7 27

22 San Francisco County, CA 2,463 330.9 28

23 Duval County, FL 2,343 285.3 29

24 New York County, NY 2,332 149.2 29

25 De Kalb County, GA 2,313 342.3 30

26 Bronx County, NY 2,299 168.4 31

27 Sacramento County, CA 2,279 168.5 32

28 Oklahoma County, OK 2,266 332.8 32

29 Bexar County, TX 2,192 146.7 33

30 Jefferson County, AL 2,171 329.7 33

31 Washington, DC 2,146 387.7 34

32 Alameda County, CA 2,119 145.6 35

33 San Bernardino County, CA 2,114 110.0 35

34 Mecklenburg County, NC 2,082 269.8 36

35 St Louis County, MO 2,038 201.9 37

36 Orange County, FL 1,990 201.0 37

37 Broward County, FL 1,980 112.8 38

38 Monroe County, NY 1,845 251.0 38

39 Essex County, NJ 1,840 231.0 39

40 Allegheny County, PA 1,802 144.1 39

41 Queens County, NY 1,802 80.5 40

42 King County, WA 1,785 100.4 40

43 Orleans County, LA 1,760 380.7 41

44 Montgomery County, OH 1,751 318.3 41

45 Hennepin County, MN 1,728 154.2 42

46 Erie County, NY 1,713 183.0 42

47 Mobile County, AL 1,673 417.7 43

48 Dade County, FL 1,661 70.3 43

49 Genesee County, MI 1,511 340.4 44

50 Caddo County, LA 1,442 573.3 44

51 Pinellas County, FL 1,423 153.3 45

52 Lucas County, OH 1,415 314.0 45

53 Orange County, CA 1,390 46.5 46

54 Jefferson County, KY 1,387 198.1 46

55 Hinds County, MS 1,364 545.6 46

56 Travis County, TX 1,364 156.8 47

57 Richmond (City), VA 1,329 690.4 47

58 Denver County, CO 1,311 235.4 48

59 Fresno County, CA 1,310 151.1 48

60 Hillsborough County, FL 1,263 114.7 48

61 Pulaski County, AR 1,232 336.7 49

62 Kern County, CA 1,224 166.6 49

63 Prince George’s County, MD 1,185 140.6 49

64 Tulsa County, OK 1,169 205.4 50

65 Kent County, MI 1,137 191.4 50

66 Charleston County, SC 1,128 345.2 50

Table 15. Gonorrhea — Counties and independent cities* ranked by number of reported cases:

United States, 2005

*Accounting for 50% of reported gonorrhea cases.

†

Counties and independent cities were ranked in descending order by number of cases reported in 2005.
STD Surveillance 2005 Gonorrhea Tables 107

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 8,731 8,825 7,355 7,838 NA 192.8 191.4 156.2 166.5

Austin-Round Rock, TX 1,813 1,656 1,458 1,472 1,706 137.1 122.7 105.8 104.2 120.8

Baltimore-Towson, MD NA 6,213 5,382 5,256 4,779 NA 238.8 205.7 199.2 181.1

Birmingham-Hoover, AL 2,812 2,693 2,212 2,377 2,381 264.8 252.1 206.2 219.6 220.0

Boston-Cambridge-Quincy, MA-NH NA 2,191 1,818 1,998 1,684 NA 49.3 40.9 45.2 38.1

Buffalo-Cheektowaga-Tonawanda, NY NA 2,224 1,809 1,670 1,926 NA 191.2 156.0 144.7 166.8

Charlotte-Gastonia-Concord, NC-SC 3,002 3,146 3,130 2,998 3,330 218.1 223.1 217.8 203.3 225.8

Chicago-Naperville-Joliet, IL-IN-WI NA 19,312 17,080 15,684 14,857 NA 208.0 183.0 167.0 158.2

Cincinnati-Middletown, OH-KY-IN 3,792 4,065 4,206 3,455 3,927 187.0 199.2 205.4 167.9 190.8

Cleveland-Elyria-Mentor, OH 5,189 5,489 5,338 4,472 4,641 241.7 255.6 249.5 209.3 217.2

Columbus, OH 3,865 3,268 2,963 3,004 3,445 235.5 196.9 176.9 177.3 203.4

Dallas-Fort Worth-Arlington, TX 9,297 7,896 7,570 7,119 8,416 173.6 144.0 135.4 124.9 147.6

Denver-Aurora, CO 2,512 2,783 2,136 2,232 2,147 111.8 122.0 92.8 95.8 92.1

Detroit-Warren-Livonia, MI 10,060 8,622 7,173 9,299 10,766 224.8 192.3 160.0 207.0 239.6

Hartford-West Hartford-East Hartford, CT 1,092 1,281 1,030 933 993 94.2 109.7 87.4 78.8 83.8

Houston-Baytown-Sugar Land, TX 6,604 6,337 5,191 5,525 5,213 136.0 127.1 102.3 106.7 100.6

Indianapolis, IN 3,496 3,660 3,349 3,510 4,142 225.0 232.4 209.9 216.5 255.4

Jacksonville, FL 2,912 3,078 2,574 2,197 2,578 253.1 261.4 214.0 179.3 210.4

Kansas City, MO-KS 3,312 3,827 3,694 3,832 3,769 177.6 202.6 193.9 199.0 195.8

Las Vegas-Paradise, NV 1,513 1,757 1,968 2,645 2,487 103.7 115.4 124.8 160.2 150.7

Los Angeles-Long Beach-Santa Ana, CA NA 9,073 9,753 11,103 12,697 NA 71.2 76.0 85.9 98.2

Louisville, KY-IN 1,609 1,517 1,617 1,484 1,551 137.1 128.3 135.9 123.6 129.2

Memphis, TN-MS-AR 5,021 4,623 3,764 3,832 3,782 412.3 375.7 303.7 306.5 302.5

Miami-Fort Lauderdale-Miami Beach, FL 4,889 4,816 4,455 4,622 4,497 95.3 92.0 84.2 86.2 83.9

Milwaukee-Waukesha-West Allis, WI NA 4,687 3,998 3,311 4,031 NA 309.9 264.0 218.4 265.9

Minneapolis-St. Paul-Bloomington, MN-WI NA 2,738 2,781 2,439 2,920 NA 89.6 90.2 78.3 93.7

Nashville-Davidson-Murfreesboro, TN 2,020 1,764 1,888 1,602 1,474 151.2 130.4 137.7 114.8 105.6

New Orleans-Metairie-Kenner, LA NA 3,679 3,956 3,316 2,609 NA 279.7 300.3 251.3 197.7

New York-Newark-Edison, NY-NJ-PA NA 19,507 20,480 16,915 15,533 NA 104.9 109.9 90.4 83.0

Oklahoma City, OK 2,209 2,090 2,050 2,153 2,548 199.4 186.4 181.0 188.1 222.7

Orlando, FL 2,678 2,502 2,165 2,285 2,848 157.0 142.8 120.1 122.7 153.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 10,087 8,502 7,818 7,719 NA 175.4 147.3 134.8 133.1

Phoenix-Mesa-Scottsdale, AZ NA NA 2,795 3,161 3,133 NA NA 77.8 85.1 84.3

Pittsburgh, PA NA 2,472 2,035 1,799 2,157 NA 102.2 84.4 74.9 89.8

Portland-Vancouver-Beaverton, OR-WA 1,032 818 858 1,173 1,393 52.2 40.6 42.1 56.8 67.5

Providence-New Bedford-Fall River, RI-MA NA 1,052 1,136 1,048 650 NA 65.2 70.0 64.3 39.9

Richmond, VA 3,239 2,746 2,319 2,160 2,361 291.2 243.8 203.7 187.1 204.5

Riverside-San Bernardino-Ontario, CA NA 2,245 2,512 2,631 3,012 NA 63.9 69.0 69.4 79.4

Rochester, NY NA 1,821 1,897 1,900 1,899 NA 174.6 182.2 182.4 182.3

Sacramento-Arden-Arcade-Roseville, CA NA 1,514 1,859 2,066 2,450 NA 78.4 94.1 102.4 121.5

Salt Lake City, UT 158 261 276 371 460 16.0 26.2 27.5 36.4 45.2

San Antonio, TX 2,240 2,078 2,333 2,183 2,300 128.0 116.3 128.1 117.7 124.1

San Diego-Carlsbad-San Marcos, CA NA 2,132 2,007 2,379 2,695 NA 73.3 68.5 81.1 91.9

San Francisco-Oakland-Fremont, CA NA 5,070 4,394 4,967 5,713 NA 121.3 105.7 119.6 137.5

San Jose-Sunnyvale-Santa Clara, CA NA 516 740 1,084 1,055 NA 29.7 42.7 62.2 60.6

Seattle-Tacoma-Bellevue, WA 2,405 2,288 2,027 1,883 2,704 77.7 73.2 64.5 59.5 85.4

St. Louis, MO-IL 6,378 5,797 5,600 5,719 6,391 234.9 212.4 204.7 206.9 231.2

Tampa-St. Petersburg-Clearwater, FL 3,089 3,679 3,160 2,801 2,910 126.3 147.7 124.8 108.2 112.4

Virginia Beach-Norfolk-Newport News, VA-NC 4,872 4,812 4,201 3,812 3,355 306.0 298.3 256.6 231.8 204.0

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 5,977 5,262 5,803 4,497 NA 118.9 103.4 112.9 87.5

U.S. MSA TOTAL 103,110 210,590 199,726 194,853 202,369 168.9 139.1 127.8 123.4 128.2

Table 16. Gonorrhea — Reported cases and rates in selected metropolitan statistical areas* (MSAs) listed in

alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
108 Gonorrhea Tables STD Surveillance 2005

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 3,967 4,177 3,563 3,567 NA 173.2 179.6 150.3 150.5

Austin-Round Rock, TX 878 815 644 692 830 135.0 122.8 95.4 100.1 120.0

Baltimore-Towson, MD NA 3,063 2,793 2,710 2,426 NA 227.0 206.0 198.2 177.5

Birmingham-Hoover, AL 1,540 1,354 1,100 1,060 1,133 279.3 244.3 197.9 189.2 202.3

Boston-Cambridge-Quincy, MA-NH NA 1,017 771 937 793 NA 44.3 33.7 41.2 34.8

Buffalo-Cheektowaga-Tonawanda, NY NA 1,167 974 920 1,079 NA 192.9 161.7 153.4 179.9

Charlotte-Gastonia-Concord, NC-SC 1,303 1,461 1,492 1,413 1,604 185.9 203.7 204.4 188.6 214.1

Chicago-Naperville-Joliet, IL-IN-WI NA 9,585 8,804 8,546 7,948 NA 202.3 185.1 178.7 166.2

Cincinnati-Middletown, OH-KY-IN 2,101 2,274 2,371 2,038 2,274 201.6 217.0 226.0 193.3 215.7

Cleveland-Elyria-Mentor, OH 2,470 2,688 2,620 2,192 2,264 220.8 240.2 235.3 197.2 203.7

Columbus, OH 1,985 1,746 1,569 1,475 1,896 237.8 206.9 184.5 171.8 220.9

Dallas-Fort Worth-Arlington, TX 4,691 3,979 3,822 3,547 4,135 174.7 144.9 136.9 124.7 145.4

Denver-Aurora, CO 1,218 1,251 1,091 1,144 996 108.6 109.9 95.2 98.7 85.9

Detroit-Warren-Livonia, MI 5,203 4,524 3,807 4,850 6,079 226.4 196.5 165.5 210.5 263.8

Hartford-West Hartford-East Hartford, CT 639 749 614 533 520 106.9 124.5 101.2 87.3 85.2

Houston-Baytown-Sugar Land, TX 3,330 3,189 2,509 2,813 3,016 136.7 127.6 98.8 108.6 116.4

Indianapolis, IN 1,811 1,847 1,659 1,698 2,163 228.2 229.9 204.1 205.7 262.0

Jacksonville, FL 1,307 1,413 1,201 1,083 1,240 221.8 234.4 195.1 173.0 198.1

Kansas City, MO-KS 1,654 1,917 1,890 2,027 2,035 173.5 198.6 194.6 206.8 207.6

Las Vegas-Paradise, NV 648 848 931 1,206 1,163 90.3 113.4 120.2 148.7 143.4

Los Angeles-Long Beach-Santa Ana, CA NA 3,879 4,371 4,997 5,687 NA 60.3 67.6 76.6 87.2

Louisville, KY-IN 735 722 767 720 740 121.7 118.7 125.6 116.9 120.2

Memphis, TN-MS-AR 2,401 2,273 1,860 1,926 1,990 379.7 356.0 289.8 297.6 307.4

Miami-Fort Lauderdale-Miami Beach, FL 2,228 2,205 2,114 2,307 2,317 84.1 81.7 77.6 83.5 83.9

Milwaukee-Waukesha-West Allis, WI NA 2,713 2,295 1,906 2,298 NA 348.6 295.0 244.9 295.2

Minneapolis-St. Paul-Bloomington, MN-WI NA 1,499 1,508 1,373 1,548 NA 97.0 96.8 87.3 98.5

Nashville-Davidson-Murfreesboro, TN 958 781 873 742 661 140.7 113.3 125.4 104.9 93.4

New Orleans-Metairie-Kenner, LA NA 1,721 1,961 1,606 1,287 NA 251.1 286.0 234.0 187.5

New York-Newark-Edison, NY-NJ-PA NA 9,755 10,650 8,821 7,784 NA 101.0 110.2 91.0 80.3

Oklahoma City, OK 1,283 1,142 1,138 1,181 1,486 227.5 200.2 197.7 203.8 256.4

Orlando, FL 1,232 1,212 1,039 1,063 1,286 142.4 136.5 113.8 112.9 136.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 5,288 4,593 4,189 4,219 NA 177.2 153.5 139.5 140.5

Phoenix-Mesa-Scottsdale, AZ NA NA 1,254 1,373 1,456 NA NA 70.3 74.5 79.0

Pittsburgh, PA NA 1,454 1,192 1,063 1,216 NA 115.3 94.9 85.0 97.2

Portland-Vancouver-Beaverton, OR-WA 400 315 331 491 551 40.2 31.1 32.3 47.4 53.2

Providence-New Bedford-Fall River, RI-MA NA 570 603 607 365 NA 68.1 71.7 72.0 43.3

Richmond, VA 1,549 1,573 1,260 1,187 1,256 269.3 270.3 214.6 199.7 211.3

Riverside-San Bernardino-Ontario, CA NA 1,129 1,289 1,323 1,572 NA 64.3 70.8 69.8 83.0

Rochester, NY NA 929 982 919 1,006 NA 173.4 183.5 172.0 188.3

Sacramento-Arden-Arcade-Roseville, CA NA 811 942 1,049 1,307 NA 82.6 93.9 102.3 127.5

Salt Lake City, UT 63 86 91 143 183 12.9 17.4 18.3 28.4 36.3

San Antonio, TX 1,178 1,083 1,152 1,109 1,155 131.6 118.6 124.0 117.2 122.0

San Diego-Carlsbad-San Marcos, CA NA 718 739 936 1,108 NA 49.7 50.8 64.2 76.0

San Francisco-Oakland-Fremont, CA NA 1,857 1,578 1,580 2,052 NA 87.8 75.2 75.4 97.9

San Jose-Sunnyvale-Santa Clara, CA NA 196 328 467 457 NA 22.8 38.4 54.6 53.4

Seattle-Tacoma-Bellevue, WA 966 853 732 717 1,060 62.2 54.4 46.5 45.2 66.8

St. Louis, MO-IL 3,340 3,174 3,037 3,213 3,638 237.3 224.5 214.5 225.0 254.7

Tampa-St. Petersburg-Clearwater, FL 1,504 1,767 1,498 1,474 1,542 118.9 137.4 114.7 110.6 115.7

Virginia Beach-Norfolk-Newport News, VA-NC 2,300 2,287 2,111 1,990 1,717 284.7 279.9 254.6 239.1 206.3

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 2,762 2,520 2,973 2,269 NA 107.2 96.6 113.1 86.3

U.S. MSA TOTAL 50,915 103,608 99,647 97,892 102,374 163.8 134.1 125.2 121.8 127.4

Table 17. Gonorrhea — Women – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
STD Surveillance 2005 Gonorrhea Tables 109

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 4,729 4,616 3,750 4,183 NA 211.2 202.0 160.4 178.9

Austin-Round Rock, TX 935 841 811 768 870 139.1 122.7 115.4 106.5 120.7

Baltimore-Towson, MD NA 3,148 2,588 2,546 2,352 NA 251.3 205.3 200.1 184.9

Birmingham-Hoover, AL 1,269 1,338 1,108 1,316 1,243 248.6 260.4 214.4 252.1 238.1

Boston-Cambridge-Quincy, MA-NH NA 1,174 1,045 1,060 890 NA 54.6 48.6 49.4 41.4

Buffalo-Cheektowaga-Tonawanda, NY NA 1,057 835 750 847 NA 189.3 149.9 135.2 152.7

Charlotte-Gastonia-Concord, NC-SC 1,698 1,682 1,638 1,583 1,726 251.5 242.7 231.5 218.1 237.8

Chicago-Naperville-Joliet, IL-IN-WI NA 9,719 8,265 7,122 6,900 NA 213.7 180.6 154.5 149.7

Cincinnati-Middletown, OH-KY-IN 1,672 1,759 1,804 1,375 1,616 169.5 177.1 180.8 136.9 160.9

Cleveland-Elyria-Mentor, OH 2,694 2,762 2,683 2,236 2,329 262.1 268.4 261.5 218.0 227.1

Columbus, OH 1,841 1,493 1,380 1,509 1,531 228.3 182.9 167.4 180.6 183.2

Dallas-Fort Worth-Arlington, TX 4,561 3,899 3,742 3,560 4,276 170.8 142.4 133.7 124.7 149.7

Denver-Aurora, CO 1,294 1,532 1,045 1,088 1,151 115.1 134.1 90.5 92.9 98.3

Detroit-Warren-Livonia, MI 4,857 4,098 3,365 4,449 4,657 223.2 187.8 154.1 203.2 212.8

Hartford-West Hartford-East Hartford, CT 450 532 416 400 473 80.1 93.9 72.8 69.7 82.4

Houston-Baytown-Sugar Land, TX 3,268 3,144 2,672 2,707 2,194 135.0 126.4 105.3 104.5 84.7

Indianapolis, IN 1,682 1,798 1,680 1,808 1,972 221.3 233.1 214.7 227.1 247.7

Jacksonville, FL 1,605 1,665 1,373 1,114 1,338 286.0 289.6 233.8 185.9 223.3

Kansas City, MO-KS 1,658 1,910 1,804 1,805 1,734 182.0 206.7 193.3 191.0 183.5

Las Vegas-Paradise, NV 863 909 1,036 1,436 1,322 116.3 117.4 129.1 171.0 157.5

Los Angeles-Long Beach-Santa Ana, CA NA 5,174 5,364 6,084 6,985 NA 81.9 84.4 95.0 109.1

Louisville, KY-IN 871 794 848 761 811 152.8 138.2 146.3 130.0 138.6

Memphis, TN-MS-AR 2,620 2,350 1,904 1,906 1,792 447.4 396.9 318.7 316.1 297.2

Miami-Fort Lauderdale-Miami Beach, FL 2,661 2,611 2,341 2,315 2,180 107.2 103.1 91.3 89.1 83.9

Milwaukee-Waukesha-West Allis, WI NA 1,966 1,682 1,405 1,731 NA 267.8 228.5 190.6 234.8

Minneapolis-St. Paul-Bloomington, MN-WI NA 1,239 1,273 1,066 1,372 NA 82.1 83.4 69.0 88.9

Nashville-Davidson-Murfreesboro, TN 1,062 983 1,015 860 813 162.1 148.1 150.4 125.0 118.1

New Orleans-Metairie-Kenner, LA NA 1,946 1,988 1,684 1,299 NA 308.9 314.6 265.9 205.1

New York-Newark-Edison, NY-NJ-PA NA 9,736 9,769 8,063 7,744 NA 108.9 108.9 89.4 85.9

Oklahoma City, OK 926 948 912 972 1,062 170.2 172.1 163.7 172.1 188.0

Orlando, FL 1,444 1,290 1,126 1,222 1,562 171.8 149.2 126.5 132.8 169.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 4,799 3,907 3,629 3,500 NA 173.4 140.5 129.7 125.1

Phoenix-Mesa-Scottsdale, AZ NA NA 1,539 1,787 1,676 NA NA 85.0 95.4 89.5

Pittsburgh, PA NA 1,018 841 736 941 NA 88.0 72.8 63.9 81.8

Portland-Vancouver-Beaverton, OR-WA 632 503 527 682 842 64.3 50.2 51.9 66.3 81.9

Providence-New Bedford-Fall River, RI-MA NA 482 532 441 285 NA 62.1 68.0 56.1 36.3

Richmond, VA 1,678 1,173 1,054 971 1,105 312.4 215.5 191.3 173.4 197.3

Riverside-San Bernardino-Ontario, CA NA 1,116 1,221 1,308 1,440 NA 63.4 67.1 68.9 75.9

Rochester, NY NA 892 915 981 893 NA 175.9 180.8 193.4 176.1

Sacramento-Arden-Arcade-Roseville, CA NA 698 897 1,002 1,123 NA 73.6 92.4 101.1 113.3

Salt Lake City, UT 95 174 185 228 277 19.1 34.6 36.4 44.2 53.8

San Antonio, TX 1,061 995 1,181 1,073 1,145 124.1 113.9 132.5 118.2 126.2

San Diego-Carlsbad-San Marcos, CA NA 1,336 1,256 1,417 1,500 NA 91.4 85.1 96.1 101.7

San Francisco-Oakland-Fremont, CA NA 3,184 2,797 3,367 3,644 NA 154.2 135.9 163.7 177.2

San Jose-Sunnyvale-Santa Clara, CA NA 310 408 617 597 NA 35.2 46.3 69.7 67.4

Seattle-Tacoma-Bellevue, WA 1,439 1,435 1,295 1,166 1,644 93.3 92.2 82.6 73.8 104.0

St. Louis, MO-IL 3,038 2,623 2,563 2,506 2,753 232.3 199.4 194.1 187.6 206.1

Tampa-St. Petersburg-Clearwater, FL 1,585 1,912 1,662 1,327 1,368 134.2 158.8 135.5 105.7 109.0

Virginia Beach-Norfolk-Newport News, VA-NC 2,556 2,525 2,077 1,816 1,636 325.9 317.3 257.0 223.7 201.5

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 3,200 2,724 2,822 2,220 NA 130.7 109.7 112.4 88.5

U.S. MSA TOTAL 52,015 106,601 99,709 96,596 99,544 173.5 143.8 130.1 124.6 128.4

Table 18. Gonorrhea — Men – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
110 Gonorrhea Tables STD Surveillance 2005

Age

Group

Cases Rates

Year Total Male Female Total Male Female

2001

10-14 6,041 862 5,179 28.9 8.0 50.8

15-19 101,065 31,952 69,113 498.6 306.5 701.8

20-24 116,207 54,604 61,603 589.5 541.7 639.7

25-29 56,083 32,181 23,902 294.8 333.6 254.9

30-34 32,537 21,050 11,487 156.5 201.1 111.3

35-39 21,799 15,216 6,583 97.7 136.5 58.9

40-44 13,605 10,072 3,533 59.6 89.0 30.7

45-54 10,458 8,655 1,803 26.7 44.9 9.0

55-64 2,255 2,003 252 8.9 16.5 1.9

65+ 843 651 192 2.4 4.5 0.9

TOTAL 361,758 177,531 184,227 126.8 126.7 126.8

2002

10-14 5,449 784 4,665 25.8 7.2 45.2

15-19 96,325 29,921 66,404 472.7 285.7 670.4

20-24 112,449 52,130 60,318 556.3 503.7 611.5

25-29 55,480 31,391 24,089 292.4 325.6 258.1

30-34 32,081 20,560 11,521 153.1 194.6 110.8

35-39 21,419 14,878 6,541 97.7 135.8 59.7

40-44 13,791 10,254 3,536 60.0 89.8 30.5

45-54 10,927 8,891 2,036 27.3 45.2 10.0

55-64 2,284 2,019 266 8.6 15.8 1.9

65+ 791 631 159 2.2 4.3 0.8

TOTAL 351,836 171,839 179,997 122.0 121.3 122.7

2003

10-14 4,929 725 4,204 23.3 6.7 40.7

15-19 90,340 27,473 62,867 441.1 261.2 631.2

20-24 106,930 48,222 58,709 515.9 452.2 583.4

25-29 53,692 29,368 24,325 280.1 300.5 258.9

30-34 30,528 19,004 11,524 147.4 181.9 112.4

35-39 20,212 13,824 6,388 94.4 128.9 59.8

40-44 13,722 10,079 3,644 59.8 88.4 31.5

45-54 11,018 8,905 2,113 27.0 44.4 10.2

55-64 2,316 2,012 303 8.3 15.0 2.1

65+ 745 617 128 2.1 4.1 0.6

TOTAL 335,104 160,459 174,645 115.2 112.2 118.2

2004

10-14 4,447 630 3,817 21.0 5.8 37.0

15-19 87,454 26,607 60,847 421.9 250.2 602.8

20-24 103,187 45,917 57,269 492.0 425.0 563.2

25-29 54,857 29,520 25,337 280.4 295.4 264.9

30-34 30,372 18,664 11,708 148.4 180.5 115.6

35-39 19,793 13,350 6,443 94.0 126.3 61.5

40-44 14,026 10,220 3,806 60.8 89.2 32.8

45-54 12,078 9,645 2,433 29.0 47.2 11.5

55-64 2,653 2,286 367 9.1 16.3 2.4

65+ 745 615 130 2.1 4.1 0.6

TOTAL 330,132 157,623 172,509 112.4 109.1 115.7

2005

10-14 4,278 646 3,631 20.2 6.0 35.2

15-19 90,840 27,781 63,060 438.2 261.2 624.7

20-24 106,280 47,187 59,093 506.8 436.8 581.2

25-29 57,195 30,631 26,565 292.4 306.5 277.7

30-34 30,044 18,244 11,800 146.8 176.4 116.5

35-39 19,948 13,413 6,535 94.8 126.9 62.3

40-44 14,346 10,406 3,940 62.2 90.8 34.0

45-54 12,636 10,063 2,573 30.4 49.2 12.2

55-64 2,777 2,399 378 9.5 17.1 2.5

65+ 763 631 132 2.1 4.2 0.6

TOTAL 339,593 161,557 178,036 115.6 111.8 119.4

Table 19. Gonorrhea — Reported cases and rates per 100,000 population by age group and sex: United

States, 2001–2005

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
This page intentionally left blank.
112 Gonorrhea Tables STD Surveillance 2005

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2001

10-14 855 57 798 4,646 715 3,932 440 80 360 53 6 47 46 3 43

15-19 14,961 2,611 12,351 77,554 26,692 50,862 7,095 2,312 4,783 763 205 559 692 130 562

20-24 16,997 5,390 11,607 89,154 44,621 44,533 8,416 4,024 4,393 881 354 526 778 231 547

25-29 8,535 3,610 4,924 42,275 25,705 16,570 4,418 2,464 1,954 512 281 231 344 124 219

30-34 6,106 3,461 2,645 23,242 15,644 7,597 2,636 1,646 990 327 205 122 220 93 127

35-39 4,720 3,026 1,694 15,136 10,957 4,178 1,630 1,055 575 160 116 44 149 59 90

40-44 2,882 1,924 958 9,749 7,496 2,253 759 513 246 111 92 19 101 46 55

45-54 2,364 1,796 568 7,386 6,356 1,030 542 398 144 84 60 25 79 45 34

55-64 583 510 73 1,510 1,374 136 124 90 33 23 16 7 14 12 2

65+ 207 163 44 554 443 111 57 29 28 17 11 6 7 3 4

TOTAL 58,323 22,585 35,738 271,871 140,235 131,636 26,190 12,624 13,566 2,935 1,348 1,588 2,439 751 1,689

2002

10-14 786 50 736 4,181 665 3,516 412 57 355 28 4 24 41 7 34

15-19 15,055 2,521 12,534 73,130 24,995 48,134 6,809 2,111 4,699 547 122 425 785 170 615

20-24 18,044 5,714 12,330 84,159 41,703 42,456 8,648 4,176 4,473 772 304 468 843 244 599

25-29 9,168 3,917 5,251 40,777 24,593 16,184 4,647 2,470 2,177 501 263 238 390 157 233

30-34 6,450 3,628 2,822 22,223 14,951 7,271 2,820 1,656 1,164 322 207 115 260 117 143

35-39 5,067 3,336 1,731 14,263 10,190 4,073 1,695 1,132 562 214 130 84 175 87 88

40-44 3,386 2,393 993 9,226 7,098 2,128 957 637 320 109 66 44 109 58 51

45-54 2,706 2,089 617 7,460 6,268 1,192 573 408 165 105 74 31 80 51 29

55-64 664 574 90 1,467 1,336 132 125 95 29 23 10 13 4 3 2

65+ 196 155 41 523 428 95 50 35 15 18 11 7 3 3 0

TOTAL 61,671 24,429 37,243 257,986 132,498 125,488 26,829 12,822 14,007 2,646 1,196 1,450 2,704 905 1,800

2003

10-14 789 51 739 3,662 594 3,068 390 71 320 31 3 28 55 7 49

15-19 15,541 2,532 13,009 66,553 22,572 43,980 7,011 2,086 4,924 533 116 417 700 163 537

20-24 19,132 6,097 13,035 77,129 37,552 39,577 9,080 4,085 4,994 840 270 570 767 229 539

25-29 9,891 4,159 5,732 38,142 22,275 15,866 4,787 2,544 2,243 499 250 249 375 146 229

30-34 6,648 3,512 3,136 20,459 13,498 6,961 2,821 1,704 1,117 381 206 175 214 83 131

35-39 5,126 3,314 1,812 12,840 9,130 3,710 1,823 1,160 663 244 139 105 174 80 94

40-44 3,835 2,634 1,201 8,642 6,626 2,016 981 654 327 145 95 49 118 70 48

45-54 2,917 2,169 748 7,268 6,172 1,096 660 467 192 105 64 41 66 32 33

55-64 713 588 125 1,439 1,301 138 123 98 25 31 19 13 8 7 2

65+ 239 196 43 443 379 64 44 29 15 11 7 4 8 6 2

TOTAL 64,961 25,288 39,673 237,038 120,266 116,771 27,793 12,922 14,872 2,823 1,171 1,652 2,489 823 1,666

2004

10-14 678 44 634 3,336 526 2,811 366 48 318 28 5 23 38 7 31

15-19 15,369 2,546 12,822 63,917 21,682 42,234 6,908 2,101 4,807 475 115 359 785 159 626

20-24 19,129 5,909 13,220 73,374 35,351 38,023 8,891 4,017 4,874 868 329 538 939 319 620

25-29 10,539 4,237 6,301 38,013 21,985 16,028 5,387 2,882 2,505 497 262 234 424 159 265

30-34 6,751 3,459 3,293 20,027 13,180 6,847 2,956 1,726 1,230 384 200 184 249 99 150

35-39 5,276 3,277 1,998 12,243 8,667 3,576 1,883 1,178 706 214 143 72 172 84 88

40-44 4,021 2,713 1,307 8,710 6,653 2,058 1,060 736 324 116 75 40 116 40 76

45-54 3,341 2,487 855 7,777 6,523 1,253 746 511 235 103 61 42 110 63 46

55-64 831 695 136 1,615 1,457 158 159 116 43 35 12 23 12 7 5

65+ 219 174 45 472 404 68 42 29 14 3 1 2 8 6 2

TOTAL 66,250 25,585 40,665 229,843 116,537 113,306 28,455 13,360 15,096 2,726 1,205 1,521 2,858 946 1,912

2005

10-14 691 35 655 3,154 549 2,604 355 52 304 25 1 23 45 8 37

15-19 15,758 2,679 13,079 66,165 22,563 43,602 7,299 2,134 5,165 606 176 430 845 196 650

20-24 20,892 6,509 14,383 73,365 35,373 37,991 9,742 4,438 5,303 960 418 542 1,012 344 668

25-29 11,681 4,667 7,013 38,213 22,200 16,013 5,915 3,126 2,790 633 341 293 569 216 353

30-34 6,790 3,405 3,385 19,172 12,540 6,632 3,248 1,830 1,418 405 281 124 314 137 177

35-39 5,384 3,256 2,127 12,004 8,570 3,433 2,009 1,270 739 268 180 88 193 97 97

40-44 4,255 2,863 1,392 8,606 6,593 2,012 1,153 776 377 146 93 53 119 44 75

45-54 3,535 2,668 867 7,993 6,667 1,325 831 561 270 118 79 39 93 46 46

55-64 853 721 132 1,653 1,490 163 191 134 57 44 28 16 24 17 6

65+ 242 203 39 452 386 66 55 36 19 8 4 4 3 1 2

TOTAL 70,209 27,050 43,159 231,076 117,025 114,050 30,845 14,374 16,471 3,214 1,602 1,612 3,225 1,112 2,113

Table 20A. Gonorrhea — Reported cases by race/ethnicity, age group and sex: United States, 2001–2005

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 19 for age-specific cases and rates and Tables 12-14 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were

specified. In 2005, HI did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 year age group is not shown because some of these

cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2005 Gonorrhea Tables 113

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10-14 6.5 0.8 12.4 141.5 42.9 243.0 13.1 4.7 21.8 6.4 1.4 11.6 19.6 2.5 37.3

2001

15-19 114.8 39.0 194.8 2,586.9 1,753.8 3,446.0 223.7 138.7 317.9 89.9 47.3 134.3 309.3 113.9 513.1

20-24 138.5 86.8 191.4 3,203.4 3,276.3 3,133.6 238.0 206.0 277.5 94.4 76.3 112.2 411.4 241.2 586.4

25-29 73.3 61.5 85.3 1,683.5 2,148.2 1,260.6 122.7 125.7 119.2 46.3 52.2 40.7 205.8 148.1 264.2

30-34 45.3 51.0 39.5 878.9 1,251.9 544.7 78.3 91.5 63.3 29.0 37.4 21.0 129.2 109.2 149.0

35-39 30.9 39.6 22.3 537.7 828.4 280.0 54.0 66.6 40.1 15.2 22.7 8.2 80.2 65.2 94.8

40-44 17.6 23.5 11.7 351.3 576.2 152.8 30.4 40.1 20.2 11.5 20.1 3.7 54.4 51.4 57.2

45-54 8.0 12.2 3.8 170.4 317.6 44.2 15.8 23.4 8.4 5.3 8.1 2.9 26.3 31.3 21.6

55-64 2.9 5.3 0.7 61.2 125.1 9.9 6.7 10.4 3.4 2.6 3.8 1.5 8.2 14.8 2.0

65+ 0.7 1.3 0.3 19.2 40.3 6.2 3.1 3.8 2.6 1.8 2.9 1.0 4.6 5.0 4.3

TOTAL 29.4 23.3 35.3 762.0 826.8 703.3 70.3 65.8 75.2 24.6 23.4 25.8 102.6 64.0 140.0

10-14 6.0 0.7 11.5 124.9 39.1 213.2 11.6 3.1 20.6 3.4 1.0 5.9 17.4 5.9 29.2

2002

15-19 115.2 37.5 197.3 2,410.6 1,621.2 3,226.2 213.0 126.8 306.6 64.2 28.1 101.6 346.9 147.5 555.1

20-24 143.4 89.7 198.3 2,927.7 2,942.8 2,913.0 239.8 209.6 277.0 81.4 64.7 97.9 427.4 244.0 616.6

25-29 80.1 67.9 92.6 1,631.8 2,062.7 1,238.6 123.8 119.9 128.5 45.1 49.0 41.5 233.3 186.1 281.2

30-34 48.4 54.1 42.6 834.8 1,187.4 518.3 78.8 86.3 70.2 26.6 35.3 18.4 152.3 137.3 167.3

35-39 34.4 45.3 23.6 514.3 781.9 277.1 53.7 68.2 37.6 19.5 24.4 14.9 96.9 97.9 96.0

40-44 20.7 29.3 12.1 329.1 540.7 142.7 36.1 46.7 24.9 10.9 13.7 8.3 58.0 64.4 52.0

45-54 9.0 14.1 4.1 165.7 301.7 49.2 15.7 22.4 9.0 6.3 9.6 3.4 26.0 34.4 18.1

55-64 3.2 5.6 0.8 57.2 116.9 9.2 6.3 10.2 2.8 2.3 2.1 2.5 2.4 3.2 1.7

65+ 0.7 1.3 0.2 17.9 38.3 5.3 2.5 4.2 1.3 1.8 2.5 1.3 1.9 4.4 0.0

TOTAL 31.0 25.1 36.7 713.7 770.7 662.1 69.2 64.1 74.6 21.4 20.0 22.6 112.5 76.3 147.6

10-14 6.0 0.8 11.6 108.3 34.6 184.4 10.7 3.8 17.9 3.7 0.6 6.9 23.9 5.7 42.7

2003

15-19 118.9 37.7 204.7 2,165.6 1,447.2 2,905.9 215.9 123.8 315.1 62.2 26.3 100.1 307.6 140.7 481.1

20-24 149.1 93.5 206.3 2,614.5 2,558.2 2,670.3 242.4 197.0 298.6 84.8 54.0 116.2 372.7 218.5 532.1

25-29 85.8 71.4 100.4 1,504.2 1,831.3 1,202.6 126.0 121.6 131.5 44.2 45.1 43.4 220.8 170.4 272.0

30-34 51.0 53.5 48.4 771.9 1,074.6 499.2 78.8 88.6 67.4 30.3 33.4 27.3 125.6 98.0 153.2

35-39 36.0 46.4 25.5 472.6 713.9 258.0 57.4 69.0 44.4 22.0 25.8 18.4 99.4 92.8 105.8

40-44 23.7 32.6 14.8 308.0 504.5 135.1 35.8 46.0 24.7 14.0 19.2 9.2 62.8 76.8 49.7

45-54 9.6 14.4 4.9 156.6 287.9 43.9 17.3 24.5 10.1 6.0 7.8 4.4 20.7 21.4 20.0

55-64 3.3 5.5 1.1 53.6 108.9 9.3 5.9 9.8 2.3 3.0 3.9 2.3 4.4 7.3 1.8

65+ 0.8 1.6 0.2 15.0 33.5 3.5 2.2 3.4 1.3 1.1 1.6 0.6 4.6 8.1 2.0

TOTAL 32.6 25.9 39.1 649.3 691.8 610.6 69.7 62.7 77.1 22.1 18.9 25.2 102.5 68.8 135.2

10-14 5.3 0.7 10.1 98.8 30.7 169.2 9.7 2.5 17.2 3.3 1.2 5.5 16.6 5.8 27.7

2004

15-19 116.8 37.7 200.4 2,032.9 1,360.8 2,723.6 207.3 122.0 298.4 54.7 25.8 85.3 342.3 136.3 556.1

20-24 147.1 89.3 207.1 2,449.7 2,357.1 2,542.6 236.2 193.8 288.0 87.2 65.4 109.4 440.7 295.1 590.4

25-29 89.9 71.6 108.6 1,457.9 1,748.9 1,187.0 137.6 132.9 143.4 43.7 47.0 40.5 243.5 180.3 308.0

30-34 53.3 54.2 52.3 761.0 1,056.8 494.6 79.9 86.6 72.0 29.5 31.4 27.7 147.4 117.7 177.0

35-39 38.2 47.3 29.1 460.3 690.9 254.4 57.6 67.7 46.1 18.6 25.4 12.1 101.3 100.0 102.5

40-44 25.0 33.8 16.2 308.0 502.7 136.7 36.7 49.1 23.3 10.7 14.5 7.2 61.5 44.2 77.7

45-54 10.9 16.3 5.5 163.2 296.5 48.9 18.5 25.3 11.7 5.7 7.2 4.3 33.8 40.8 27.3

55-64 3.7 6.3 1.2 57.4 116.2 10.1 7.2 11.0 3.7 3.1 2.3 3.9 5.7 6.8 4.7

65+ 0.7 1.4 0.3 15.7 35.1 3.7 2.0 3.1 1.1 0.3 0.3 0.3 4.4 7.6 2.0

TOTAL 33.2 26.1 40.0 622.5 662.5 586.2 68.9 62.6 75.6 20.7 18.8 22.4 116.5 78.3 153.6

10-14 5.4 0.5 10.5 93.5 32.1 156.9 9.4 2.7 16.5 3.0 0.3 5.9 20.0 7.1 33.2

2005

15-19 120.0 39.7 204.7 2,106.3 1,417.5 2,814.0 219.6 124.3 321.5 74.3 42.0 108.6 369.0 167.8 577.8

20-24 161.0 98.6 225.7 2,452.9 2,362.8 2,543.1 259.4 214.7 314.2 101.4 87.4 115.7 475.8 319.2 636.7

25-29 99.8 79.0 121.0 1,467.5 1,769.0 1,187.1 151.4 144.4 160.1 58.0 63.6 52.6 327.5 246.4 410.3

30-34 53.7 53.5 53.9 729.5 1,007.0 479.6 87.9 92.0 83.2 32.4 45.9 19.3 185.9 162.8 208.8

35-39 39.1 47.1 31.0 451.8 684.2 244.5 61.5 73.1 48.4 24.4 33.5 15.6 113.7 115.1 112.4

40-44 26.5 35.7 17.3 304.5 498.7 133.8 40.0 51.8 27.3 14.3 18.9 10.1 63.3 48.5 77.2

45-54 11.5 17.6 5.6 167.8 303.3 51.7 20.7 27.8 13.5 7.0 10.0 4.3 28.7 30.0 27.5

55-64 3.8 6.5 1.1 58.8 119.0 10.4 8.6 12.7 4.9 4.2 5.8 2.9 11.8 18.0 6.0

65+ 0.8 1.6 0.2 15.1 33.6 3.6 2.6 3.9 1.6 0.8 1.0 0.7 1.9 1.9 2.0

TOTAL 35.2 27.7 42.5 626.4 666.0 590.4 74.8 67.5 82.7 25.9 26.6 25.3 131.7 92.2 170.0

Table 20B. Gonorrhea — Rates per 100,000 population by race/ethnicity, age group and sex: United States,

2001–2005

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 19 for age-specific cases and rates and Tables 12-14 for total

and sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these

variables were specified. In 2005, HI did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded.

Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 year age group is not shown because

some of these cases may not be due to sexual transmission; however, they are included in the totals.
114 Syphilis Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 724 700 567 639 551 16.2 15.6 12.6 14.1 12.2

Alaska 9 9 8 15 22 1.4 1.4 1.2 2.3 3.4

Arizona 1,149 1,086 1,106 974 792 21.7 19.9 19.8 17.0 13.8

Arkansas 239 219 296 249 231 8.9 8.1 10.9 9.0 8.4

California 3,053 3,917 4,207 4,588 5,340 8.8 11.2 11.9 12.8 14.9

Colorado 149 174 144 179 144 3.4 3.9 3.2 3.9 3.1

Connecticut 165 188 207 169 166 4.8 5.4 5.9 4.8 4.7

Delaware 79 62 47 61 35 9.9 7.7 5.7 7.3 4.2

Florida 2,915 3,280 3,283 2,964 2,888 17.8 19.6 19.3 17.0 16.6

Georgia 1,988 1,896 2,152 1,589 1,924 23.7 22.1 24.8 18.0 21.8

Hawaii 41 59 61 36 57 3.3 4.7 4.9 2.9 4.5

Idaho 11 23 45 78 54 0.8 1.7 3.3 5.6 3.9

Illinois 1,547 1,593 1,377 1,348 1,608 12.4 12.6 10.9 10.6 12.6

Indiana 529 320 367 273 288 8.6 5.2 5.9 4.4 4.6

Iowa 44 54 46 36 28 1.5 1.8 1.6 1.2 0.9

Kansas 88 77 77 87 88 3.3 2.8 2.8 3.2 3.2

Kentucky 191 212 160 151 129 4.7 5.2 3.9 3.6 3.1

Louisiana 793 776 1,581 1,645 1,237 17.7 17.3 35.2 36.4 27.4

Maine 16 9 21 7 6 1.2 0.7 1.6 0.5 0.5

Maryland 938 843 975 1,002 1,005 17.4 15.4 17.7 18.0 18.1

Massachusetts 446 541 644 517 398 7.0 8.4 10.0 8.1 6.2

Michigan 1,170 1,184 860 806 488 11.7 11.8 8.5 8.0 4.8

Minnesota 132 148 195 145 206 2.6 2.9 3.9 2.8 4.0

Mississippi 654 451 435 404 371 22.9 15.7 15.1 13.9 12.8

Missouri 174 204 207 269 372 3.1 3.6 3.6 4.7 6.5

Montana 0 5 0 4 7 0.0 0.5 0.0 0.4 0.8

Nebraska 16 25 27 15 18 0.9 1.4 1.6 0.9 1.0

Nevada 62 113 149 253 343 3.0 5.2 6.6 10.8 14.7

New Hampshire 21 24 37 26 33 1.7 1.9 2.9 2.0 2.5

New Jersey 1,040 1,062 1,089 826 813 12.2 12.4 12.6 9.5 9.3

New Mexico 78 117 205 251 183 4.3 6.3 10.9 13.2 9.6

New York 3,610 3,885 4,360 4,472 3,851 18.9 20.3 22.7 23.3 20.0

North Carolina 1,422 1,051 850 747 712 17.3 12.6 10.1 8.7 8.3

North Dakota 2 0 2 0 1 0.3 0.0 0.3 0.0 0.2

Ohio 297 351 481 571 502 2.6 3.1 4.2 5.0 4.4

Oklahoma 288 287 353 168 159 8.3 8.2 10.1 4.8 4.5

Oregon 48 75 118 108 109 1.4 2.1 3.3 3.0 3.0

Pennsylvania 726 689 706 574 712 5.9 5.6 5.7 4.6 5.7

Rhode Island 39 67 90 104 64 3.7 6.3 8.4 9.6 5.9

South Carolina 916 620 552 524 549 22.5 15.1 13.3 12.5 13.1

South Dakota 1 0 5 0 4 0.1 0.0 0.7 0.0 0.5

Tennessee 1,478 1,082 881 804 916 25.7 18.7 15.1 13.6 15.5

Texas 3,662 4,109 3,996 4,205 4,287 17.1 18.9 18.1 18.7 19.1

Utah 25 71 72 78 50 1.1 3.1 3.1 3.3 2.1

Vermont 8 2 1 3 1 1.3 0.3 0.2 0.5 0.2

Virginia 525 528 552 610 655 7.3 7.2 7.5 8.2 8.8

Washington 174 158 239 336 359 2.9 2.6 3.9 5.4 5.8

West Virginia 7 5 11 18 18 0.4 0.3 0.6 1.0 1.0

Wisconsin 131 135 111 128 138 2.4 2.5 2.0 2.3 2.5

Wyoming 4 1 4 6 1 0.8 0.2 0.8 1.2 0.2

U.S. TOTAL† 32,283 32,918 34,289 33,419 33,278 11.3 11.4 11.8 11.4 11.3

Northeast 6,071 6,467 7,155 6,698 6,044 11.3 11.9 13.2 12.3 11.1

Midwest 4,131 4,091 3,755 3,678 3,741 6.4 6.3 5.7 5.6 5.7

South 17,278 16,552 17,021 16,137 16,032 16.9 16.0 16.3 15.2 15.1

West 4,803 5,808 6,358 6,906 7,461 7.4 8.8 9.6 10.2 11.1

Guam 30 19 16 13 19 18.9 11.8 9.8 7.8 11.4

Puerto Rico 1,268 1,394 1,357 1,154 1,223 33.0 36.1 35.0 29.6 31.4

Virgin Islands 9 4 14 17 13 8.2 3.6 12.9 15.6 12.0

OUTLYING AREAS 1,307 1,417 1,387 1,184 1,255 31.8 34.3 33.4 28.4 30.1

TOTAL 33,590 34,335 35,676 34,603 34,533 11.6 11.7 12.1 11.6 11.6

Table 21. All stages of syphilis* — Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2001–2005

*See Appendix (Syphilis Morbidity Reporting) for definition.

†

Includes cases reported by Washington, D.C.
STD Surveillance 2005 Syphilis Tables 115

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 1,430 1,702 1,315 1,626 NA 31.6 36.9 27.9 34.5

Austin-Round Rock, TX 141 111 152 200 193 10.7 8.2 11.0 14.2 13.7

Baltimore-Towson, MD NA 549 648 647 679 NA 21.1 24.8 24.5 25.7

Birmingham-Hoover, AL 172 147 122 117 243 16.2 13.8 11.4 10.8 22.5

Boston-Cambridge-Quincy, MA-NH NA 478 568 410 339 NA 10.8 12.8 9.3 7.7

Buffalo-Cheektowaga-Tonawanda, NY NA 12 11 24 14 NA 1.0 0.9 2.1 1.2

Charlotte-Gastonia-Concord, NC-SC 221 163 167 154 235 16.1 11.6 11.6 10.4 15.9

Chicago-Naperville-Joliet, IL-IN-WI NA 1,493 1,341 1,296 1,541 NA 16.1 14.4 13.8 16.4

Cincinnati-Middletown, OH-KY-IN 30 35 18 54 55 1.5 1.7 0.9 2.6 2.7

Cleveland-Elyria-Mentor, OH 48 39 62 84 52 2.2 1.8 2.9 3.9 2.4

Columbus, OH 160 214 266 254 227 9.7 12.9 15.9 15.0 13.4

Dallas-Fort Worth-Arlington, TX 1,033 1,515 1,505 1,374 1,495 19.3 27.6 26.9 24.1 26.2

Denver-Aurora, CO 112 141 116 135 111 5.0 6.2 5.0 5.8 4.8

Detroit-Warren-Livonia, MI 1,080 1,083 751 679 390 24.1 24.2 16.7 15.1 8.7

Hartford-West Hartford-East Hartford, CT 57 68 70 46 57 4.9 5.8 5.9 3.9 4.8

Houston-Baytown-Sugar Land, TX 1,059 1,158 1,256 1,289 1,188 21.8 23.2 24.7 24.9 22.9

Indianapolis, IN 325 148 142 128 134 20.9 9.4 8.9 7.9 8.3

Jacksonville, FL 152 81 135 218 151 13.2 6.9 11.2 17.8 12.3

Kansas City, MO-KS 54 74 118 101 193 2.9 3.9 6.2 5.2 10.0

Las Vegas-Paradise, NV 34 81 123 224 300 2.3 5.3 7.8 13.6 18.2

Los Angeles-Long Beach-Santa Ana, CA NA 2,104 2,166 2,482 3,159 NA 16.5 16.9 19.2 24.4

Louisville, KY-IN 115 161 126 115 102 9.8 13.6 10.6 9.6 8.5

Memphis, TN-MS-AR 1,003 632 547 519 584 82.4 51.4 44.1 41.5 46.7

Miami-Fort Lauderdale-Miami Beach, FL 1,541 1,933 1,911 1,687 1,444 30.0 36.9 36.1 31.5 26.9

Milwaukee-Waukesha-West Allis, WI NA 100 74 85 77 NA 6.6 4.9 5.6 5.1

Minneapolis-St. Paul-Bloomington, MN-WI NA 131 173 125 186 NA 4.3 5.6 4.0 6.0

Nashville-Davidson-Murfreesboro, TN 410 338 220 194 189 30.7 25.0 16.0 13.9 13.5

New Orleans-Metairie-Kenner, LA NA 130 264 449 349 NA 9.9 20.0 34.0 26.4

New York-Newark-Edison, NY-NJ-PA NA 4,672 5,101 4,918 4,316 NA 25.1 27.4 26.3 23.1

Oklahoma City, OK 207 210 253 110 87 18.7 18.7 22.3 9.6 7.6

Orlando, FL 452 402 318 267 413 26.5 22.9 17.6 14.3 22.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 721 785 678 583 NA 12.5 13.6 11.7 10.1

Phoenix-Mesa-Scottsdale, AZ NA NA 914 754 595 NA NA 25.4 20.3 16.0

Pittsburgh, PA NA 52 57 32 112 NA 2.2 2.4 1.3 4.7

Portland-Vancouver-Beaverton, OR-WA 43 66 103 84 94 2.2 3.3 5.0 4.1 4.6

Providence-New Bedford-Fall River, RI-MA NA 90 127 137 75 NA 5.6 7.8 8.4 4.6

Richmond, VA 87 85 114 85 87 7.8 7.5 10.0 7.4 7.5

Riverside-San Bernardino-Ontario, CA NA 275 313 319 399 NA 7.8 8.6 8.4 10.5

Rochester, NY NA 19 33 41 36 NA 1.8 3.2 3.9 3.5

Sacramento-Arden-Arcade-Roseville, CA NA 48 35 64 39 NA 2.5 1.8 3.2 1.9

Salt Lake City, UT 10 50 43 53 35 1.0 5.0 4.3 5.2 3.4

San Antonio, TX 377 322 231 361 458 21.5 18.0 12.7 19.5 24.7

San Diego-Carlsbad-San Marcos, CA NA 162 299 356 448 NA 5.6 10.2 12.1 15.3

San Francisco-Oakland-Fremont, CA NA 870 901 917 719 NA 20.8 21.7 22.1 17.3

San Jose-Sunnyvale-Santa Clara, CA NA 94 137 113 121 NA 5.4 7.9 6.5 6.9

Seattle-Tacoma-Bellevue, WA 133 127 174 273 285 4.3 4.1 5.5 8.6 9.0

St. Louis, MO-IL 192 160 150 189 173 7.1 5.9 5.5 6.8 6.3

Tampa-St. Petersburg-Clearwater, FL 198 316 407 303 326 8.1 12.7 16.1 11.7 12.6

Virginia Beach-Norfolk-Newport News, VA-NC 202 185 148 198 246 12.7 11.5 9.0 12.0 15.0

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 871 836 896 894 NA 17.3 16.4 17.4 17.4

U.S. MSA TOTAL 9,648 24,346 26,233 25,553 25,854 15.8 16.1 16.8 16.2 16.4

Table 22. All stages of syphilis* — Reported cases and rates in selected metropolitan statistical areas†

(MSAs) listed in alphabetical order: United States, 2001–2005

*See Appendix (Reporting of Syphilis Cases) for definition.

†

MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
116 Syphilis Tables STD Surveillance 2005

Rank* State/Area Cases Rate per 100,000 Population

1 Georgia 645 7.3

2 Louisiana 278 6.2

3 Maryland 313 5.6

4 Nevada 109 4.7

5 California 1,585 4.4

6 Florida 724 4.2

7 Illinois 525 4.1

8 Texas 873 3.9

9 Alabama 169 3.7

10 Tennessee 217 3.7

11 New York 705 3.7

12 North Carolina 274 3.2

13 Arizona 175 3.0

U.S. TOTAL† 8,724 3.0

14 New Mexico 56 2.9

15 Missouri 147 2.6

16 Washington 152 2.5

17 Rhode Island 24 2.2

18 South Carolina 84 2.0

19 Massachusetts 125 1.9

20 Virginia 143 1.9

21 Arkansas 52 1.9

22 Ohio 211 1.8

23 Mississippi 49 1.7

24 Connecticut 58 1.7

25 Pennsylvania 199 1.6

26 New Jersey 133 1.5

27 Idaho 20 1.4

28 Alaska 9 1.4

29 Minnesota 70 1.4

30 Delaware 11 1.3

31 Kentucky 52 1.3

32 Oklahoma 44 1.2

33 New Hampshire 16 1.2

34 Oregon 41 1.1

35 Michigan 105 1.0

36 Colorado 46 1.0

37 Indiana 62 1.0

38 Hawaii 11 0.9

39 Montana 7 0.8

40 Wisconsin 41 0.7

41 Kansas 19 0.7

42 Utah 10 0.4

43 Iowa 9 0.3

44 South Dakota 2 0.3

YEAR 2010 TARGET 0.2

45 Nebraska 4 0.2

46 West Virginia 3 0.2

47 Vermont 1 0.2

48 North Dakota 1 0.2

49 Maine 1 0.1

Wyoming 0 0.0

Table 23. Primary and secondary syphilis — Reported cases and rates by state/area, ranked by rates:

United States, 2005

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 2 cases and rate of 1.2, Puerto Rico with 226 cases and

rate of 5.8, and Virgin Islands with 1 case and rate of 0.9).
STD Surveillance 2005 Syphilis Tables 117

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 142 149 114 165 169 3.2 3.3 2.5 3.6 3.7

Alaska 0 0 1 8 9 0.0 0.0 0.2 1.2 1.4

Arizona 180 200 186 157 175 3.4 3.7 3.3 2.7 3.0

Arkansas 49 34 51 47 52 1.8 1.3 1.9 1.7 1.9

California 545 1,033 1,299 1,356 1,585 1.6 2.9 3.7 3.8 4.4

Colorado 23 64 39 63 46 0.5 1.4 0.9 1.4 1.0

Connecticut 12 28 30 45 58 0.3 0.8 0.9 1.3 1.7

Delaware 14 11 7 9 11 1.8 1.4 0.9 1.1 1.3

Florida 484 617 658 728 724 3.0 3.7 3.9 4.2 4.2

Georgia 414 439 585 549 645 4.9 5.1 6.7 6.2 7.3

Hawaii 12 11 14 8 11 1.0 0.9 1.1 0.6 0.9

Idaho 1 8 15 24 20 0.1 0.6 1.1 1.7 1.4

Illinois 409 479 374 386 525 3.3 3.8 3.0 3.0 4.1

Indiana 151 62 50 60 62 2.5 1.0 0.8 1.0 1.0

Iowa 5 8 12 5 9 0.2 0.3 0.4 0.2 0.3

Kansas 25 20 25 24 19 0.9 0.7 0.9 0.9 0.7

Kentucky 48 88 33 47 52 1.2 2.2 0.8 1.1 1.3

Louisiana 173 152 183 332 278 3.9 3.4 4.1 7.4 6.2

Maine 1 2 8 2 1 0.1 0.2 0.6 0.2 0.1

Maryland 266 228 312 380 313 4.9 4.2 5.7 6.8 5.6

Massachusetts 46 99 133 114 125 0.7 1.5 2.1 1.8 1.9

Michigan 428 486 249 192 105 4.3 4.8 2.5 1.9 1.0

Minnesota 33 59 47 27 70 0.7 1.2 0.9 0.5 1.4

Mississippi 140 49 40 59 49 4.9 1.7 1.4 2.0 1.7

Missouri 26 34 61 94 147 0.5 0.6 1.1 1.6 2.6

Montana 0 0 0 4 7 0.0 0.0 0.0 0.4 0.8

Nebraska 10 6 10 7 4 0.6 0.3 0.6 0.4 0.2

Nevada 8 15 12 40 109 0.4 0.7 0.5 1.7 4.7

New Hampshire 1 8 19 5 16 0.1 0.6 1.5 0.4 1.2

New Jersey 137 169 170 150 133 1.6 2.0 2.0 1.7 1.5

New Mexico 19 39 71 82 56 1.0 2.1 3.8 4.3 2.9

New York 304 478 584 727 705 1.6 2.5 3.0 3.8 3.7

North Carolina 445 279 152 192 274 5.4 3.4 1.8 2.2 3.2

North Dakota 0 0 2 0 1 0.0 0.0 0.3 0.0 0.2

Ohio 81 159 197 237 211 0.7 1.4 1.7 2.1 1.8

Oklahoma 60 72 64 25 44 1.7 2.1 1.8 0.7 1.2

Oregon 13 28 48 29 41 0.4 0.8 1.3 0.8 1.1

Pennsylvania 100 105 159 118 199 0.8 0.9 1.3 1.0 1.6

Rhode Island 9 13 33 26 24 0.8 1.2 3.1 2.4 2.2

South Carolina 235 134 94 116 84 5.8 3.3 2.3 2.8 2.0

South Dakota 1 0 2 0 2 0.1 0.0 0.3 0.0 0.3

Tennessee 331 168 135 130 217 5.8 2.9 2.3 2.2 3.7

Texas 478 589 654 827 873 2.2 2.7 3.0 3.7 3.9

Utah 11 7 14 13 10 0.5 0.3 0.6 0.5 0.4

Vermont 3 2 1 1 1 0.5 0.3 0.2 0.2 0.2

Virginia 102 71 82 116 143 1.4 1.0 1.1 1.6 1.9

Washington 57 70 82 150 152 1.0 1.2 1.3 2.4 2.5

West Virginia 5 2 2 3 3 0.3 0.1 0.1 0.2 0.2

Wisconsin 22 30 16 29 41 0.4 0.6 0.3 0.5 0.7

Wyoming 1 0 0 3 0 0.2 0.0 0.0 0.6 0.0

U.S. TOTAL* 6,103 6,862 7,177 7,980 8,724 2.1 2.4 2.5 2.7 3.0

Northeast 613 904 1,137 1,188 1,262 1.1 1.7 2.1 2.2 2.3

Midwest 1,191 1,343 1,045 1,061 1,196 1.8 2.1 1.6 1.6 1.8

South 3,429 3,140 3,214 3,794 4,045 3.4 3.0 3.1 3.6 3.8

West 870 1,475 1,781 1,937 2,221 1.3 2.2 2.7 2.9 3.3

Guam 12 6 1 0 2 7.6 3.7 0.6 0.0 1.2

Puerto Rico 244 270 202 182 226 6.4 7.0 5.2 4.7 5.8

Virgin Islands 0 1 3 5 1 0.0 0.9 2.8 4.6 0.9

OUTLYING AREAS 256 277 206 187 229 6.2 6.7 5.0 4.5 5.5

TOTAL 6,359 7,139 7,383 8,167 8,953 2.2 2.4 2.5 2.7 3.0

Table 24. Primary and secondary syphilis — Reported cases and rates by state/area and region listed in

alphabetical order: United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.
118 Syphilis Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 67 63 49 52 69 2.9 2.7 2.1 2.2 3.0

Alaska 0 0 0 0 1 0.0 0.0 0.0 0.0 0.3

Arizona 50 74 66 42 49 1.9 2.7 2.4 1.5 1.7

Arkansas 27 18 16 18 21 2.0 1.3 1.1 1.3 1.5

California 42 39 52 63 121 0.2 0.2 0.3 0.4 0.7

Colorado 5 2 5 7 2 0.2 0.1 0.2 0.3 0.1

Connecticut 2 3 3 3 2 0.1 0.2 0.2 0.2 0.1

Delaware 5 4 2 1 2 1.2 1.0 0.5 0.2 0.5

Florida 135 108 73 98 100 1.6 1.3 0.8 1.1 1.1

Georgia 129 98 68 45 47 3.0 2.3 1.5 1.0 1.1

Hawaii 0 2 0 0 0 0.0 0.3 0.0 0.0 0.0

Idaho 0 4 5 11 6 0.0 0.6 0.7 1.6 0.9

Illinois 91 81 48 55 47 1.4 1.3 0.7 0.9 0.7

Indiana 71 18 16 6 10 2.3 0.6 0.5 0.2 0.3

Iowa 1 4 2 1 1 0.1 0.3 0.1 0.1 0.1

Kansas 11 6 13 7 2 0.8 0.4 0.9 0.5 0.1

Kentucky 17 43 13 6 3 0.8 2.1 0.6 0.3 0.1

Louisiana 83 76 79 123 112 3.6 3.3 3.4 5.3 4.8

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 113 53 74 92 88 4.1 1.9 2.6 3.2 3.1

Massachusetts 4 12 3 5 4 0.1 0.4 0.1 0.2 0.1

Michigan 161 192 93 61 20 3.2 3.8 1.8 1.2 0.4

Minnesota 16 4 4 3 2 0.6 0.2 0.2 0.1 0.1

Mississippi 69 31 20 19 12 4.7 2.1 1.3 1.3 0.8

Missouri 8 10 14 12 12 0.3 0.3 0.5 0.4 0.4

Montana 0 0 0 1 1 0.0 0.0 0.0 0.2 0.2

Nebraska 8 2 1 4 0 0.9 0.2 0.1 0.5 0.0

Nevada 1 1 3 8 24 0.1 0.1 0.3 0.7 2.1

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 44 48 49 38 17 1.0 1.1 1.1 0.9 0.4

New Mexico 6 12 23 36 16 0.6 1.3 2.4 3.7 1.7

New York 23 26 26 32 28 0.2 0.3 0.3 0.3 0.3

North Carolina 191 115 47 48 58 4.6 2.7 1.1 1.1 1.3

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 26 27 40 61 40 0.4 0.5 0.7 1.0 0.7

Oklahoma 28 20 20 9 17 1.6 1.1 1.1 0.5 1.0

Oregon 2 8 3 1 2 0.1 0.5 0.2 0.1 0.1

Pennsylvania 28 22 33 16 34 0.4 0.3 0.5 0.3 0.5

Rhode Island 0 2 8 10 6 0.0 0.4 1.4 1.8 1.1

South Carolina 101 58 24 25 17 4.8 2.7 1.1 1.2 0.8

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 158 82 40 34 64 5.4 2.8 1.3 1.1 2.1

Texas 169 192 162 179 243 1.6 1.8 1.5 1.6 2.2

Utah 2 0 3 3 1 0.2 0.0 0.3 0.3 0.1

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 43 17 7 6 19 1.2 0.5 0.2 0.2 0.5

Washington 7 1 4 6 5 0.2 0.0 0.1 0.2 0.2

West Virginia 1 1 2 1 0 0.1 0.1 0.2 0.1 0.0

Wisconsin 13 6 1 2 3 0.5 0.2 0.0 0.1 0.1

Wyoming 1 0 0 1 0 0.4 0.0 0.0 0.4 0.0

U.S. TOTAL* 1,967 1,594 1,217 1,255 1,339 1.4 1.1 0.8 0.8 0.9

Northeast 101 113 122 104 91 0.4 0.4 0.4 0.4 0.3

Midwest 406 350 232 212 137 1.2 1.1 0.7 0.6 0.4

South 1,344 988 699 760 883 2.6 1.9 1.3 1.4 1.6

West 116 143 164 179 228 0.4 0.4 0.5 0.5 0.7

Guam 5 2 0 0 1 6.5 2.5 0.0 0.0 1.2

Puerto Rico 130 123 93 62 82 6.5 6.1 4.6 3.1 4.1

Virgin Islands 0 0 2 3 0 0.0 0.0 3.5 5.3 0.0

OUTLYING AREAS 135 125 95 65 83 6.3 5.8 4.4 3.0 3.8

TOTAL 2,102 1,719 1,312 1,320 1,422 1.4 1.2 0.9 0.9 0.9

Table 25. Primary and secondary syphilis — Women – Reported cases and rates by state/area and region

listed in alphabetical order: United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2005 Syphilis Tables 119

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 75 86 65 113 100 3.5 4.0 3.0 5.1 4.6

Alaska 0 0 1 8 8 0.0 0.0 0.3 2.4 2.4

Arizona 130 126 120 115 125 4.9 4.6 4.3 4.0 4.3

Arkansas 22 16 35 29 31 1.7 1.2 2.6 2.2 2.3

California 501 994 1,245 1,291 1,463 2.9 5.7 7.0 7.2 8.2

Colorado 18 62 34 56 44 0.8 2.7 1.5 2.4 1.9

Connecticut 10 25 27 42 56 0.6 1.5 1.6 2.5 3.3

Delaware 9 7 5 8 9 2.3 1.8 1.3 2.0 2.2

Florida 349 509 585 630 624 4.4 6.2 7.0 7.4 7.3

Georgia 285 340 517 504 598 6.9 8.1 12.1 11.5 13.7

Hawaii 12 9 14 8 11 1.9 1.4 2.2 1.3 1.7

Idaho 1 4 10 13 14 0.2 0.6 1.5 1.9 2.0

Illinois 318 398 326 331 478 5.2 6.4 5.2 5.3 7.7

Indiana 80 44 34 54 52 2.7 1.5 1.1 1.8 1.7

Iowa 4 4 10 3 8 0.3 0.3 0.7 0.2 0.6

Kansas 14 14 12 17 17 1.0 1.0 0.9 1.3 1.3

Kentucky 31 45 19 41 49 1.6 2.2 0.9 2.0 2.4

Louisiana 90 76 104 209 166 4.2 3.5 4.8 9.5 7.6

Maine 1 2 8 2 1 0.2 0.3 1.3 0.3 0.2

Maryland 153 175 238 288 225 5.9 6.6 8.9 10.7 8.4

Massachusetts 42 87 129 109 121 1.4 2.8 4.1 3.5 3.9

Michigan 267 294 156 131 85 5.4 6.0 3.2 2.6 1.7

Minnesota 17 55 43 24 68 0.7 2.2 1.7 0.9 2.7

Mississippi 71 18 20 40 37 5.1 1.3 1.4 2.8 2.6

Missouri 18 24 47 82 135 0.7 0.9 1.7 2.9 4.8

Montana 0 0 0 3 6 0.0 0.0 0.0 0.6 1.3

Nebraska 2 4 9 3 4 0.2 0.5 1.0 0.3 0.5

Nevada 7 14 9 32 85 0.7 1.3 0.8 2.7 7.2

New Hampshire 1 8 19 5 16 0.2 1.3 3.0 0.8 2.5

New Jersey 93 121 121 112 116 2.3 2.9 2.9 2.6 2.7

New Mexico 13 27 48 46 40 1.4 3.0 5.2 4.9 4.3

New York 281 452 558 695 677 3.1 4.9 6.0 7.5 7.3

North Carolina 254 164 105 144 216 6.3 4.0 2.5 3.4 5.1

North Dakota 0 0 2 0 1 0.0 0.0 0.6 0.0 0.3

Ohio 55 132 157 176 171 1.0 2.4 2.8 3.2 3.1

Oklahoma 32 52 44 16 27 1.9 3.0 2.5 0.9 1.6

Oregon 11 20 45 28 39 0.6 1.1 2.5 1.6 2.2

Pennsylvania 72 83 126 102 165 1.2 1.4 2.1 1.7 2.7

Rhode Island 9 11 25 16 18 1.8 2.1 4.8 3.1 3.5

South Carolina 134 76 70 91 67 6.8 3.8 3.5 4.4 3.3

South Dakota 1 0 2 0 2 0.3 0.0 0.5 0.0 0.5

Tennessee 173 86 95 96 153 6.2 3.0 3.3 3.3 5.3

Texas 309 397 492 648 630 2.9 3.7 4.5 5.8 5.6

Utah 9 7 11 10 9 0.8 0.6 0.9 0.8 0.8

Vermont 3 2 1 1 1 1.0 0.7 0.3 0.3 0.3

Virginia 59 54 75 110 124 1.7 1.5 2.1 3.0 3.4

Washington 50 69 78 144 147 1.7 2.3 2.6 4.7 4.8

West Virginia 4 1 0 2 3 0.5 0.1 0.0 0.2 0.3

Wisconsin 9 24 15 27 38 0.3 0.9 0.6 1.0 1.4

Wyoming 0 0 0 2 0 0.0 0.0 0.0 0.8 0.0

U.S. TOTAL* 4,134 5,267 5,956 6,722 7,383 3.0 3.7 4.2 4.7 5.1

Northeast 512 791 1,014 1,084 1,171 2.0 3.0 3.8 4.1 4.4

Midwest 785 993 813 848 1,059 2.5 3.1 2.5 2.6 3.3

South 2,085 2,151 2,514 3,034 3,162 4.2 4.2 4.9 5.8 6.1

West 752 1,332 1,615 1,756 1,991 2.3 4.1 4.9 5.2 5.9

Guam 7 4 1 0 1 8.7 4.9 1.2 0.0 1.2

Puerto Rico 114 147 109 120 144 6.2 7.9 5.8 6.4 7.7

Virgin Islands 0 1 1 2 1 0.0 2.0 1.9 3.9 1.9

OUTLYING AREAS 121 152 111 122 146 6.1 7.6 5.5 6.1 7.3

TOTAL 4,255 5,419 6,067 6,844 7,529 3.0 3.8 4.2 4.7 5.1

Table 26. Primary and secondary syphilis — Men – Reported cases and rates by state/area and region listed

in alphabetical order: United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.

NOTE: Cases reported with unknown sex are not included in this table.
120 Syphilis Tables STD Surveillance 2005

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Los Angeles County, CA 709 7.1 8

2 Cook County, IL 462 8.7 13

3 Fulton County, GA 293 36.0 16

4 New York County, NY 277 17.7 19

5 Harris County, TX 252 6.9 22

6 San Francisco County, CA 249 33.5 25

7 Broward County, FL 196 11.2 27

8 Baltimore (City), MD 195 30.6 30

9 San Diego County, CA 194 6.6 32

10 Kings County, NY 182 7.4 34

11 De Kalb County, GA 177 26.2 36

12 Dallas County, TX 172 7.5 38

13 Dade County, FL 168 7.1 40

14 Shelby County, TN 130 14.3 41

15 Bexar County, TX 127 8.5 43

16 King County, WA 119 6.7 44

17 Washington, DC 114 20.6 46

18 Maricopa County, AZ 110 3.1 47

19 East Baton Rouge County, LA 108 26.2 48

20 Riverside County, CA 107 5.7 49

21 Tarrant County, TX 104 6.5 50

22 Franklin County, OH 103 9.5 52

23 Clark County, NV 103 6.2 53

24 Orange County, FL 98 9.9 54

25 Orange County, CA 97 3.2 55

26 Jefferson County, AL 95 14.4 56

27 Philadelphia County, PA 86 5.8 57

28 Mecklenburg County, NC 85 11.0 58

29 Queens County, NY 83 3.7 59

30 Orleans County, LA 68 14.7 60

31 Bronx County, NY 67 4.9 61

32 Suffolk County, MA 64 9.6 61

33 Wayne County, MI 64 3.2 62

34 Allegheny County, PA 61 4.9 63

35 Jackson County, MO 59 8.9 63

36 Cobb County, GA 56 8.6 64

37 Pima County, AZ 54 6.0 65

38 Hennepin County, MN 50 4.5 65

39 Duval County, FL 49 6.0 66

40 Prince George’s County, MD 49 5.8 66

41 Alameda County, CA 49 3.4 67

42 Santa Clara County, CA 43 2.6 67

43 Pinellas County, FL 42 4.5 68

44 Wake County, NC 41 5.7 68

45 Hillsborough County, FL 41 3.7 69

46 Jefferson County, KY 39 5.6 69

47 Travis County, TX 37 4.3 70

48 McLennan County, TX 36 16.2 70

49 Hudson County, NJ 35 5.8 71

50 Essex County, NJ 35 4.4 71

51 St Louis (City), MO 34 9.9 71

52 Guilford County, NC 33 7.5 72

53 Marion County, IN 31 3.6 72

54 Palm Beach County, FL 31 2.5 72

55 Denver County, CO 28 5.0 73

56 Bernalillo County, NM 28 4.7 73

57 New Haven County, CT 28 3.3 73

58 Middlesex County, MA 28 1.9 74

59 Multnomah County, OR 27 4.0 74

60 Gwinnett County, GA 27 3.9 74

61 Knox County, TN 25 6.2 75

62 Tangipahoa County, LA 24 22.8 75

63 Davidson County, TN 24 4.2 75

64 Richland County, SC 23 6.9 75

Table 27. Primary and secondary syphilis — Counties and independent cities* ranked by number of reported

cases: United States, 2005

*Accounting for 75% of reported primary and secondary syphilis cases.

†

Counties and independent cities were ranked in descending order by number of cases reported in 2005.
STD Surveillance 2005 Syphilis Tables 121

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 378 516 508 598 NA 8.3 11.2 10.8 12.7

Austin-Round Rock, TX 21 23 31 56 44 1.6 1.7 2.3 4.0 3.1

Baltimore-Towson, MD NA 163 224 276 244 NA 6.3 8.6 10.5 9.2

Birmingham-Hoover, AL 16 13 23 33 101 1.5 1.2 2.1 3.0 9.3

Boston-Cambridge-Quincy, MA-NH NA 84 121 84 106 NA 1.9 2.7 1.9 2.4

Buffalo-Cheektowaga-Tonawanda, NY NA 3 2 9 7 NA 0.3 0.2 0.8 0.6

Charlotte-Gastonia-Concord, NC-SC 59 45 23 46 103 4.3 3.2 1.6 3.1 7.0

Chicago-Naperville-Joliet, IL-IN-WI NA 433 346 373 510 NA 4.7 3.7 4.0 5.4

Cincinnati-Middletown, OH-KY-IN 5 7 2 22 24 0.2 0.3 0.1 1.1 1.2

Cleveland-Elyria-Mentor, OH 3 14 32 40 22 0.1 0.7 1.5 1.9 1.0

Columbus, OH 64 107 120 109 109 3.9 6.4 7.2 6.4 6.4

Dallas-Fort Worth-Arlington, TX 166 309 265 279 305 3.1 5.6 4.7 4.9 5.4

Denver-Aurora, CO 19 55 32 55 38 0.8 2.4 1.4 2.4 1.6

Detroit-Warren-Livonia, MI 408 466 218 153 77 9.1 10.4 4.9 3.4 1.7

Hartford-West Hartford-East Hartford, CT 3 11 16 13 14 0.3 0.9 1.4 1.1 1.2

Houston-Baytown-Sugar Land, TX 114 124 227 235 279 2.3 2.5 4.5 4.5 5.4

Indianapolis, IN 128 39 25 34 35 8.2 2.5 1.6 2.1 2.2

Jacksonville, FL 40 18 21 72 50 3.5 1.5 1.7 5.9 4.1

Kansas City, MO-KS 10 17 43 35 89 0.5 0.9 2.3 1.8 4.6

Las Vegas-Paradise, NV 4 7 8 38 103 0.3 0.5 0.5 2.3 6.2

Los Angeles-Long Beach-Santa Ana, CA NA 433 562 551 806 NA 3.4 4.4 4.3 6.2

Louisville, KY-IN 23 83 28 38 46 2.0 7.0 2.4 3.2 3.8

Memphis, TN-MS-AR 250 111 90 99 138 20.5 9.0 7.3 7.9 11.0

Miami-Fort Lauderdale-Miami Beach, FL 259 391 409 434 395 5.0 7.5 7.7 8.1 7.4

Milwaukee-Waukesha-West Allis, WI NA 23 11 19 22 NA 1.5 0.7 1.3 1.5

Minneapolis-St. Paul-Bloomington, MN-WI NA 55 43 26 68 NA 1.8 1.4 0.8 2.2

Nashville-Davidson-Murfreesboro, TN 80 33 26 17 34 6.0 2.4 1.9 1.2 2.4

New Orleans-Metairie-Kenner, LA NA 13 28 101 88 NA 1.0 2.1 7.7 6.7

New York-Newark-Edison, NY-NJ-PA NA 602 709 816 773 NA 3.2 3.8 4.4 4.1

Oklahoma City, OK 46 65 56 20 23 4.2 5.8 4.9 1.7 2.0

Orlando, FL 61 67 70 69 106 3.6 3.8 3.9 3.7 5.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 103 135 95 127 NA 1.8 2.3 1.6 2.2

Phoenix-Mesa-Scottsdale, AZ NA NA 134 106 113 NA NA 3.7 2.9 3.0

Pittsburgh, PA NA 24 38 22 69 NA 1.0 1.6 0.9 2.9

Portland-Vancouver-Beaverton, OR-WA 10 28 47 26 39 0.5 1.4 2.3 1.3 1.9

Providence-New Bedford-Fall River, RI-MA NA 20 42 30 28 NA 1.2 2.6 1.8 1.7

Richmond, VA 11 9 12 11 13 1.0 0.8 1.1 1.0 1.1

Riverside-San Bernardino-Ontario, CA NA 64 91 103 121 NA 1.8 2.5 2.7 3.2

Rochester, NY NA 6 7 12 6 NA 0.6 0.7 1.2 0.6

Sacramento-Arden-Arcade-Roseville, CA NA 14 19 19 16 NA 0.7 1.0 0.9 0.8

Salt Lake City, UT 4 7 6 5 9 0.4 0.7 0.6 0.5 0.9

San Antonio, TX 73 48 52 116 129 4.2 2.7 2.9 6.3 7.0

San Diego-Carlsbad-San Marcos, CA NA 37 111 138 194 NA 1.3 3.8 4.7 6.6

San Francisco-Oakland-Fremont, CA NA 399 406 422 331 NA 9.5 9.8 10.2 8.0

San Jose-Sunnyvale-Santa Clara, CA NA 30 56 56 44 NA 1.7 3.2 3.2 2.5

Seattle-Tacoma-Bellevue, WA 48 59 70 138 125 1.6 1.9 2.2 4.4 3.9

St. Louis, MO-IL 41 32 51 71 50 1.5 1.2 1.9 2.6 1.8

Tampa-St. Petersburg-Clearwater, FL 28 57 96 89 85 1.1 2.3 3.8 3.4 3.3

Virginia Beach-Norfolk-Newport News, VA-NC 53 31 23 50 60 3.3 1.9 1.4 3.0 3.6

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 139 168 199 233 NA 2.8 3.3 3.9 4.5

U.S. MSA TOTAL 2,047 5,299 5,891 6,368 7,149 3.4 3.5 3.8 4.0 4.5

Table 28. Primary and secondary syphilis — Reported cases and rates in selected metropolitan statistical

areas* (MSAs) listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
122 Syphilis Tables STD Surveillance 2005

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 74 57 36 36 NA 3.2 2.5 1.5 1.5

Austin-Round Rock, TX 4 3 2 3 3 0.6 0.5 0.3 0.4 0.4

Baltimore-Towson, MD NA 47 63 70 84 NA 3.5 4.6 5.1 6.1

Birmingham-Hoover, AL 9 7 4 11 35 1.6 1.3 0.7 2.0 6.2

Boston-Cambridge-Quincy, MA-NH NA 8 2 5 1 NA 0.3 0.1 0.2 0.0

Buffalo-Cheektowaga-Tonawanda, NY NA 0 1 1 0 NA 0.0 0.2 0.2 0.0

Charlotte-Gastonia-Concord, NC-SC 20 22 3 12 20 2.9 3.1 0.4 1.6 2.7

Chicago-Naperville-Joliet, IL-IN-WI NA 62 44 55 50 NA 1.3 0.9 1.1 1.0

Cincinnati-Middletown, OH-KY-IN 2 2 0 2 0 0.2 0.2 0.0 0.2 0.0

Cleveland-Elyria-Mentor, OH 2 4 13 3 1 0.2 0.4 1.2 0.3 0.1

Columbus, OH 20 11 17 31 22 2.4 1.3 2.0 3.6 2.6

Dallas-Fort Worth-Arlington, TX 68 123 99 73 100 2.5 4.5 3.5 2.6 3.5

Denver-Aurora, CO 3 0 3 6 1 0.3 0.0 0.3 0.5 0.1

Detroit-Warren-Livonia, MI 158 188 81 49 17 6.9 8.2 3.5 2.1 0.7

Hartford-West Hartford-East Hartford, CT 0 1 3 0 0 0.0 0.2 0.5 0.0 0.0

Houston-Baytown-Sugar Land, TX 33 19 26 39 61 1.4 0.8 1.0 1.5 2.4

Indianapolis, IN 60 11 7 2 4 7.6 1.4 0.9 0.2 0.5

Jacksonville, FL 18 8 9 32 20 3.1 1.3 1.5 5.1 3.2

Kansas City, MO-KS 3 3 20 5 5 0.3 0.3 2.1 0.5 0.5

Las Vegas-Paradise, NV 0 0 1 8 21 0.0 0.0 0.1 1.0 2.6

Los Angeles-Long Beach-Santa Ana, CA NA 19 28 40 63 NA 0.3 0.4 0.6 1.0

Louisville, KY-IN 10 42 13 6 3 1.7 6.9 2.1 1.0 0.5

Memphis, TN-MS-AR 123 62 30 33 50 19.5 9.7 4.7 5.1 7.7

Miami-Fort Lauderdale-Miami Beach, FL 55 48 33 41 43 2.1 1.8 1.2 1.5 1.6

Milwaukee-Waukesha-West Allis, WI NA 5 1 1 1 NA 0.6 0.1 0.1 0.1

Minneapolis-St. Paul-Bloomington, MN-WI NA 3 3 3 3 NA 0.2 0.2 0.2 0.2

Nashville-Davidson-Murfreesboro, TN 32 13 6 2 2 4.7 1.9 0.9 0.3 0.3

New Orleans-Metairie-Kenner, LA NA 4 10 27 23 NA 0.6 1.5 3.9 3.4

New York-Newark-Edison, NY-NJ-PA NA 65 65 58 37 NA 0.7 0.7 0.6 0.4

Oklahoma City, OK 24 15 19 7 9 4.3 2.6 3.3 1.2 1.6

Orlando, FL 17 22 17 10 14 2.0 2.5 1.9 1.1 1.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 22 23 16 13 NA 0.7 0.8 0.5 0.4

Phoenix-Mesa-Scottsdale, AZ NA NA 45 25 23 NA NA 2.5 1.4 1.2

Pittsburgh, PA NA 8 17 7 25 NA 0.6 1.4 0.6 2.0

Portland-Vancouver-Beaverton, OR-WA 1 8 2 0 0 0.1 0.8 0.2 0.0 0.0

Providence-New Bedford-Fall River, RI-MA NA 5 9 10 7 NA 0.6 1.1 1.2 0.8

Richmond, VA 4 2 2 1 1 0.7 0.3 0.3 0.2 0.2

Riverside-San Bernardino-Ontario, CA NA 2 5 1 12 NA 0.1 0.3 0.1 0.6

Rochester, NY NA 1 1 0 1 NA 0.2 0.2 0.0 0.2

Sacramento-Arden-Arcade-Roseville, CA NA 0 1 0 0 NA 0.0 0.1 0.0 0.0

Salt Lake City, UT 1 0 1 1 1 0.2 0.0 0.2 0.2 0.2

San Antonio, TX 26 12 6 20 34 2.9 1.3 0.6 2.1 3.6

San Diego-Carlsbad-San Marcos, CA NA 6 4 10 25 NA 0.4 0.3 0.7 1.7

San Francisco-Oakland-Fremont, CA NA 6 4 2 8 NA 0.3 0.2 0.1 0.4

San Jose-Sunnyvale-Santa Clara, CA NA 1 4 4 2 NA 0.1 0.5 0.5 0.2

Seattle-Tacoma-Bellevue, WA 1 0 2 6 4 0.1 0.0 0.1 0.4 0.3

St. Louis, MO-IL 18 12 12 9 5 1.3 0.8 0.8 0.6 0.4

Tampa-St. Petersburg-Clearwater, FL 9 10 6 3 8 0.7 0.8 0.5 0.2 0.6

Virginia Beach-Norfolk-Newport News, VA-NC 28 12 3 4 15 3.5 1.5 0.4 0.5 1.8

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 15 13 16 13 NA 0.6 0.5 0.6 0.5

U.S. MSA TOTAL 749 1,013 840 806 926 2.4 1.3 1.1 1.0 1.2

Table 29. Primary and secondary syphilis — Women – Reported cases and rates in selected metropolitan

statistical areas* (MSAs) listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific case counts

and rates to be determined for some jurisdictions for some years.
STD Surveillance 2005 Syphilis Tables 123

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 303 459 472 562 NA 13.5 20.1 20.2 24.0

Austin-Round Rock, TX 17 20 29 53 41 2.5 2.9 4.1 7.4 5.7

Baltimore-Towson, MD NA 116 161 206 160 NA 9.3 12.8 16.2 12.6

Birmingham-Hoover, AL 7 6 19 22 66 1.4 1.2 3.7 4.2 12.6

Boston-Cambridge-Quincy, MA-NH NA 76 119 79 105 NA 3.5 5.5 3.7 4.9

Buffalo-Cheektowaga-Tonawanda, NY NA 3 1 8 7 NA 0.5 0.2 1.4 1.3

Charlotte-Gastonia-Concord, NC-SC 39 23 20 34 83 5.8 3.3 2.8 4.7 11.4

Chicago-Naperville-Joliet, IL-IN-WI NA 371 302 318 460 NA 8.2 6.6 6.9 10.0

Cincinnati-Middletown, OH-KY-IN 3 5 2 20 24 0.3 0.5 0.2 2.0 2.4

Cleveland-Elyria-Mentor, OH 1 10 19 37 21 0.1 1.0 1.9 3.6 2.0

Columbus, OH 44 96 103 78 87 5.5 11.8 12.5 9.3 10.4

Dallas-Fort Worth-Arlington, TX 98 186 166 206 205 3.7 6.8 5.9 7.2 7.2

Denver-Aurora, CO 16 55 29 49 37 1.4 4.8 2.5 4.2 3.2

Detroit-Warren-Livonia, MI 250 278 137 104 60 11.5 12.7 6.3 4.8 2.7

Hartford-West Hartford-East Hartford, CT 3 10 13 13 14 0.5 1.8 2.3 2.3 2.4

Houston-Baytown-Sugar Land, TX 81 105 201 196 218 3.3 4.2 7.9 7.6 8.4

Indianapolis, IN 68 28 18 32 31 8.9 3.6 2.3 4.0 3.9

Jacksonville, FL 22 10 12 40 30 3.9 1.7 2.0 6.7 5.0

Kansas City, MO-KS 7 14 23 30 84 0.8 1.5 2.5 3.2 8.9

Las Vegas-Paradise, NV 4 7 7 30 82 0.5 0.9 0.9 3.6 9.8

Los Angeles-Long Beach-Santa Ana, CA NA 414 533 511 743 NA 6.6 8.4 8.0 11.6

Louisville, KY-IN 13 41 14 32 43 2.3 7.1 2.4 5.5 7.3

Memphis, TN-MS-AR 127 49 60 66 88 21.7 8.3 10.0 10.9 14.6

Miami-Fort Lauderdale-Miami Beach, FL 204 343 376 393 352 8.2 13.5 14.7 15.1 13.5

Milwaukee-Waukesha-West Allis, WI NA 18 10 18 21 NA 2.5 1.4 2.4 2.8

Minneapolis-St. Paul-Bloomington, MN-WI NA 52 40 23 65 NA 3.4 2.6 1.5 4.2

Nashville-Davidson-Murfreesboro, TN 48 20 20 15 32 7.3 3.0 3.0 2.2 4.6

New Orleans-Metairie-Kenner, LA NA 9 18 74 65 NA 1.4 2.8 11.7 10.3

New York-Newark-Edison, NY-NJ-PA NA 537 644 758 736 NA 6.0 7.2 8.4 8.2

Oklahoma City, OK 22 50 37 13 14 4.0 9.1 6.6 2.3 2.5

Orlando, FL 44 45 53 59 92 5.2 5.2 6.0 6.4 10.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 81 112 79 114 NA 2.9 4.0 2.8 4.1

Phoenix-Mesa-Scottsdale, AZ NA NA 89 81 89 NA NA 4.9 4.3 4.8

Pittsburgh, PA NA 16 21 15 44 NA 1.4 1.8 1.3 3.8

Portland-Vancouver-Beaverton, OR-WA 9 20 45 26 39 0.9 2.0 4.4 2.5 3.8

Providence-New Bedford-Fall River, RI-MA NA 15 33 20 21 NA 1.9 4.2 2.5 2.7

Richmond, VA 7 7 10 10 12 1.3 1.3 1.8 1.8 2.1

Riverside-San Bernardino-Ontario, CA NA 62 86 102 108 NA 3.5 4.7 5.4 5.7

Rochester, NY NA 5 6 12 5 NA 1.0 1.2 2.4 1.0

Sacramento-Arden-Arcade-Roseville, CA NA 14 18 19 16 NA 1.5 1.9 1.9 1.6

Salt Lake City, UT 3 7 5 4 8 0.6 1.4 1.0 0.8 1.6

San Antonio, TX 47 36 46 96 95 5.5 4.1 5.2 10.6 10.5

San Diego-Carlsbad-San Marcos, CA NA 31 107 128 169 NA 2.1 7.3 8.7 11.5

San Francisco-Oakland-Fremont, CA NA 393 401 419 323 NA 19.0 19.5 20.4 15.7

San Jose-Sunnyvale-Santa Clara, CA NA 29 52 52 42 NA 3.3 5.9 5.9 4.7

Seattle-Tacoma-Bellevue, WA 47 59 68 132 121 3.0 3.8 4.3 8.3 7.7

St. Louis, MO-IL 23 20 39 62 45 1.8 1.5 3.0 4.6 3.4

Tampa-St. Petersburg-Clearwater, FL 19 47 90 86 77 1.6 3.9 7.3 6.9 6.1

Virginia Beach-Norfolk-Newport News, VA-NC 25 19 20 46 45 3.2 2.4 2.5 5.7 5.5

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 124 155 183 220 NA 5.1 6.2 7.3 8.8

U.S. MSA TOTAL 1,298 4,285 5,048 5,561 6,221 4.3 5.8 6.6 7.2 8.0

Table 30. Primary and secondary syphilis — Men – Reported cases and rates in selected metropolitan

statistical areas* (MSAs) listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific case counts

and rates to be determined for some jurisdictions for some years.
124 Syphilis Tables STD Surveillance 2005

Age

Group

Cases Rates

Year Total Male Female Total Male Female

2001

10-14 19 2 17 0.1 0.0 0.2

15-19 387 142 245 1.9 1.4 2.5

20-24 836 482 354 4.2 4.8 3.7

25-29 876 583 293 4.6 6.0 3.1

30-34 964 660 304 4.6 6.3 2.9

35-39 1,146 818 328 5.1 7.3 2.9

40-44 808 587 221 3.5 5.2 1.9

45-54 805 632 173 2.1 3.3 0.9

55-64 193 167 26 0.8 1.4 0.2

65+ 64 57 7 0.2 0.4 0.0

TOTAL 6,100 4,132 1,968 2.1 2.9 1.4

2002

10-14 15 4 11 0.1 0.0 0.1

15-19 351 135 216 1.7 1.3 2.2

20-24 842 533 309 4.2 5.2 3.1

25-29 895 668 227 4.7 6.9 2.4

30-34 1,097 877 220 5.2 8.3 2.1

35-39 1,367 1,121 246 6.2 10.2 2.2

40-44 1,023 845 178 4.4 7.4 1.5

45-54 982 825 157 2.5 4.2 0.8

55-64 217 196 21 0.8 1.5 0.2

65+ 67 59 8 0.2 0.4 0.0

TOTAL 6,862 5,268 1,594 2.4 3.7 1.1

2003

10-14 11 1 10 0.1 0.0 0.1

15-19 322 150 172 1.6 1.4 1.7

20-24 860 620 240 4.2 5.8 2.4

25-29 941 760 181 4.9 7.8 1.9

30-34 1,187 1,023 164 5.7 9.8 1.6

35-39 1,460 1,290 170 6.8 12.0 1.6

40-44 1,157 1,021 136 5.0 8.9 1.2

45-54 991 871 119 2.4 4.3 0.6

55-64 205 187 18 0.7 1.4 0.1

65+ 42 36 6 0.1 0.2 0.0

TOTAL 7,177 5,959 1,218 2.5 4.2 0.8

2004

10-14 9 2 7 0.0 0.0 0.1

15-19 339 191 148 1.7 1.8 1.5

20-24 1,029 735 294 5.0 6.9 2.9

25-29 1,125 943 182 5.8 9.5 1.9

30-34 1,282 1,116 166 6.3 10.9 1.7

35-39 1,467 1,313 154 7.0 12.5 1.5

40-44 1,344 1,198 146 5.9 10.6 1.3

45-54 1,035 915 120 2.5 4.5 0.6

55-64 281 249 32 1.0 1.8 0.2

65+ 55 54 1 0.2 0.4 0.0

TOTAL 7,975 6,721 1,254 2.7 4.7 0.8

2005

10-14 10 2 8 0.0 0.0 0.1

15-19 443 251 192 2.1 2.4 1.9

20-24 1,181 875 306 5.6 8.1 3.0

25-29 1,214 1,008 206 6.2 10.1 2.1

30-34 1,329 1,178 150 6.5 11.4 1.5

35-39 1,574 1,394 179 7.5 13.2 1.7

40-44 1,418 1,253 164 6.1 10.9 1.4

45-54 1,192 1,080 111 2.9 5.3 0.5

55-64 304 284 20 1.0 2.0 0.1

65+ 59 57 2 0.2 0.4 0.0

TOTAL 8,724 7,385 1,339 3.0 5.1 0.9

Table 31. Primary and secondary syphilis — Reported cases and rates per 100,000 population by age group

and sex: United States, 2001–2005

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
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126 Syphilis Tables STD Surveillance 2005

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2001

10-14 0 0 0 17 1 16 211000000

15-19 32 13 19 290 97 193 59 29 29 211422

20-24 114 72 42 562 296 266 138 105 34 6 5 1 15 4 11

25-29 152 121 31 554 323 231 140 115 26 13 13 0 18 11 6

30-34 236 192 44 563 330 233 137 117 20 12 12 0 17 9 7

35-39 332 281 51 653 397 255 134 120 13 15 14 1 13 5 7

40-44 227 193 34 505 335 170 59 48 11 2 2 0 15 10 5

45-54 220 196 24 513 377 137 61 52 9431642

55-64 51 48 3 121 100 21 18 16 2220220

65+ 23 22 1 36 30 6 4 4 0 0 0 0 1 1 0

TOTAL 1,387 1,138 249 3,813 2,286 1,527 754 607 146 55 51 4 90 49 41

2002

10-14 2 1 1 10 28211101000

15-19 33 9 24 253 89 164 62 37 25 202101

20-24 129 89 40 546 313 233 146 117 29 13 94853

25-29 224 189 36 485 323 163 165 138 26 17 16 1431

30-34 404 373 31 476 310 166 192 172 20 22 21 1312

35-39 576 541 35 568 385 183 200 178 22 15 14 1835

40-44 452 429 23 448 305 142 102 93 8 15 14 1743

45-54 393 370 23 482 370 112 83 69 15 8 8 0 16 8 7

55-64 95 91 4 110 94 16 10 10 0000211

65+ 15 15 0 42 35 7 9 8 1 0 0 0 1 1 0

TOTAL 2,325 2,108 217 3,421 2,226 1,195 971 823 147 94 83 11 51 27 24

2003

10-14 000514505000101

15-19 48 24 24 205 93 112 63 28 35 651000

20-24 195 154 41 471 309 161 178 142 36 13 11 2330

25-29 301 265 36 408 293 115 195 173 23 28 25 3844

30-34 524 485 39 416 316 100 213 190 23 20 20 0 14 12 2

35-39 743 703 40 451 335 116 222 211 11 28 28 0 16 14 2

40-44 588 563 26 382 288 94 158 146 12 20 19 1953

45-54 489 472 17 373 287 86 107 97 9 10 8 1 13 6 6

55-64 104 100 4 81 68 13 13 12 1220440

65+ 17 16 1 18 16 2 5 2 3 0 0 0 1 1 0

TOTAL 3,010 2,783 227 2,811 2,005 805 1,160 1,001 159 127 119 8 69 50 19

2004

10-14 000826101000000

15-19 56 33 23 211 113 98 55 33 22 11 92633

20-24 242 185 57 573 375 198 188 156 32 19 16 3844

25-29 317 281 36 534 421 113 237 213 24 28 25 3 11 5 5

30-34 512 470 41 496 402 95 238 215 23 29 28 1 10 3 6

35-39 675 640 35 489 392 98 249 235 14 36 35 1 18 12 6

40-44 684 655 29 455 353 102 179 169 9 18 18 0 10 4 5

45-54 525 503 23 379 295 84 110 98 12 11 11 0 10 9 1

55-64 155 145 10 101 83 18 20 20 0211413

65+ 36 35 1 16 16 0 3 3 0 0 0 0 0 0 0

TOTAL 3,203 2,947 256 3,266 2,452 814 1,280 1,142 138 153 142 11 77 42 35

2005

10-14 000918110000000

15-19 67 36 30 304 173 131 62 36 26 541514

20-24 281 230 51 660 459 201 216 167 49 15 11 4871

25-29 331 299 32 612 480 132 236 198 38 27 25 2862

30-34 491 456 35 554 455 99 230 216 14 43 42 1 12 10 2

35-39 761 712 49 518 415 103 268 244 24 19 19 0844

40-44 741 700 40 446 350 97 193 172 21 26 24 2 12 7 4

45-54 660 631 29 385 320 65 126 111 14 15 14 1642

55-64 167 162 5 102 90 13 30 28 2440000

65+ 26 26 0 23 21 2 8 8 0 2 2 0 0 0 0

TOTAL 3,524 3,254 270 3,615 2,764 850 1,370 1,182 188 156 145 11 60 40 20

Table 32A. Primary and secondary syphilis — Reported cases by race/ethnicity, age group and sex: United States,

2001–2005

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 31 for age-specific cases and rates and Tables 24-26 for total

and sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these

variables were specified. Differences between total cases from this table and others in the report are due to different reporting formats and above listed exclusion. The 0 to 9 year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2005 Syphilis Tables 127

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10-14 0.0 0.0 0.0 0.5 0.1 1.0 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2001

15-19 0.2 0.2 0.3 9.7 6.4 13.1 1.8 1.8 1.9 0.2 0.2 0.2 1.8 1.8 1.8

20-24 0.9 1.2 0.7 20.2 21.8 18.7 3.9 5.4 2.1 0.7 1.1 0.2 8.1 4.2 12.1

25-29 1.3 2.1 0.5 22.1 27.0 17.6 3.9 5.8 1.6 1.1 2.3 0.0 10.6 13.7 7.4

30-34 1.8 2.8 0.7 21.3 26.4 16.7 4.1 6.5 1.3 1.0 2.1 0.0 9.8 11.2 8.4

35-39 2.2 3.7 0.7 23.2 30.0 17.1 4.4 7.6 0.9 1.4 2.7 0.2 6.7 5.9 7.6

40-44 1.4 2.4 0.4 18.2 25.7 11.6 2.4 3.7 0.9 0.2 0.5 0.0 7.9 10.6 5.3

45-54 0.7 1.3 0.2 11.8 18.8 5.9 1.8 3.1 0.5 0.3 0.4 0.1 2.1 2.9 1.3

55-64 0.3 0.5 0.0 4.9 9.1 1.5 0.9 1.8 0.2 0.2 0.5 0.0 1.2 2.5 0.0

65+ 0.1 0.2 0.0 1.2 2.7 0.3 0.2 0.5 0.0 0.0 0.0 0.0 0.7 1.5 0.0

TOTAL 0.7 1.2 0.2 10.7 13.5 8.2 2.0 3.2 0.8 0.5 0.9 0.1 3.8 4.2 3.4

10-14 0.0 0.0 0.0 0.3 0.1 0.5 0.1 0.1 0.1 0.1 0.0 0.2 0.0 0.0 0.0

2002

15-19 0.3 0.1 0.4 8.3 5.8 11.0 1.9 2.2 1.6 0.2 0.0 0.5 0.4 0.0 0.9

20-24 1.0 1.4 0.6 19.0 22.1 16.0 4.0 5.9 1.8 1.4 2.0 0.9 4.2 5.2 3.2

25-29 2.0 3.3 0.6 19.4 27.1 12.5 4.4 6.7 1.6 1.5 2.9 0.2 2.5 3.8 1.2

30-34 3.0 5.6 0.5 17.9 24.6 11.8 5.4 9.0 1.2 1.8 3.5 0.2 1.9 1.3 2.4

35-39 3.9 7.3 0.5 20.5 29.5 12.5 6.3 10.7 1.5 1.4 2.7 0.2 4.6 3.7 5.5

40-44 2.8 5.3 0.3 16.0 23.2 9.6 3.8 6.8 0.7 1.5 2.8 0.2 3.9 4.6 3.2

45-54 1.3 2.5 0.2 10.7 17.8 4.6 2.3 3.8 0.8 0.5 1.1 0.0 5.1 5.7 4.5

55-64 0.5 0.9 0.0 4.3 8.2 1.1 0.5 1.1 0.0 0.0 0.0 0.0 1.1 1.2 1.1

65+ 0.0 0.1 0.0 1.4 3.1 0.4 0.5 1.0 0.1 0.0 0.0 0.0 0.7 1.5 0.0

TOTAL 1.2 2.2 0.2 9.5 13.0 6.3 2.5 4.1 0.8 0.8 1.4 0.2 2.1 2.3 1.9

10-14 0.0 0.0 0.0 0.1 0.1 0.2 0.1 0.0 0.3 0.0 0.0 0.0 0.4 0.0 0.9

2003

15-19 0.4 0.4 0.4 6.7 5.9 7.4 1.9 1.7 2.2 0.7 1.2 0.2 0.0 0.0 0.0

20-24 1.5 2.4 0.6 16.0 21.1 10.9 4.8 6.8 2.2 1.4 2.3 0.4 1.5 3.0 0.0

25-29 2.6 4.6 0.6 16.1 24.1 8.7 5.1 8.3 1.3 2.5 4.4 0.5 4.9 5.0 4.9

30-34 4.0 7.4 0.6 15.7 25.2 7.2 5.9 9.9 1.4 1.6 3.3 0.0 8.1 13.8 2.4

35-39 5.2 9.8 0.6 16.6 26.2 8.1 7.0 12.5 0.8 2.6 5.3 0.0 9.0 15.9 2.3

40-44 3.6 7.0 0.3 13.6 21.9 6.3 5.8 10.3 0.9 1.9 3.7 0.2 4.5 6.0 3.2

45-54 1.6 3.1 0.1 8.0 13.4 3.4 2.8 5.1 0.5 0.5 1.0 0.1 4.0 4.2 3.8

55-64 0.5 0.9 0.0 3.0 5.7 0.9 0.6 1.2 0.1 0.2 0.5 0.0 2.3 4.8 0.0

65+ 0.1 0.1 0.0 0.6 1.4 0.1 0.3 0.3 0.3 0.0 0.0 0.0 0.7 1.5 0.0

TOTAL 1.5 2.8 0.2 7.7 11.5 4.2 2.9 4.9 0.8 1.0 1.9 0.1 2.8 4.2 1.5

10-14 0.0 0.0 0.0 0.2 0.1 0.4 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2004

15-19 0.4 0.5 0.4 6.7 7.1 6.3 1.6 1.9 1.3 1.2 1.9 0.5 2.7 2.7 2.8

20-24 1.9 2.8 0.9 19.1 25.0 13.2 5.0 7.5 1.9 1.9 3.1 0.6 3.9 3.9 3.9

25-29 2.7 4.7 0.6 20.5 33.5 8.4 6.1 9.8 1.4 2.4 4.4 0.5 6.1 6.1 6.0

30-34 4.0 7.4 0.7 18.9 32.2 6.8 6.4 10.8 1.4 2.3 4.4 0.2 5.7 3.9 7.5

35-39 4.9 9.2 0.5 18.4 31.2 6.9 7.6 13.5 0.9 3.1 6.2 0.2 10.6 14.1 7.1

40-44 4.3 8.2 0.4 16.1 26.7 6.8 6.2 11.3 0.7 1.7 3.6 0.0 5.1 4.7 5.4

45-54 1.7 3.3 0.1 8.0 13.4 3.3 2.7 4.8 0.6 0.6 1.3 0.0 3.0 5.6 0.6

55-64 0.7 1.3 0.1 3.6 6.6 1.2 0.9 1.9 0.0 0.2 0.2 0.2 2.0 1.1 2.9

65+ 0.1 0.3 0.0 0.5 1.4 0.0 0.1 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0

TOTAL 1.6 3.0 0.3 8.8 13.9 4.2 3.1 5.4 0.7 1.2 2.2 0.2 3.1 3.5 2.8

10-14 0.0 0.0 0.0 0.3 0.1 0.5 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2005

15-19 0.5 0.5 0.5 9.7 10.9 8.4 1.9 2.1 1.6 0.6 0.9 0.2 2.3 0.9 3.7

20-24 2.2 3.5 0.8 22.0 30.6 13.5 5.7 8.1 2.9 1.6 2.3 0.8 3.9 6.7 1.0

25-29 2.8 5.0 0.5 23.5 38.2 9.8 6.0 9.1 2.2 2.4 4.5 0.4 4.8 6.8 2.7

30-34 3.9 7.1 0.6 21.0 36.5 7.1 6.2 10.8 0.8 3.3 6.6 0.2 6.9 11.4 2.5

35-39 5.5 10.3 0.7 19.5 33.1 7.3 8.2 14.0 1.5 1.6 3.3 0.0 5.0 5.2 4.7

40-44 4.6 8.7 0.5 15.8 26.4 6.4 6.7 11.5 1.5 2.4 4.5 0.4 6.1 8.2 4.2

45-54 2.2 4.1 0.2 8.1 14.5 2.5 3.1 5.5 0.7 0.8 1.6 0.1 1.9 2.7 1.2

55-64 0.7 1.5 0.0 3.6 7.1 0.8 1.4 2.7 0.2 0.4 0.8 0.0 0.0 0.0 0.0

65+ 0.1 0.2 0.0 0.8 1.8 0.1 0.4 0.9 0.0 0.2 0.4 0.0 0.0 0.0 0.0

TOTAL 1.8 3.3 0.3 9.8 15.7 4.4 3.3 5.5 0.9 1.2 2.3 0.2 2.4 3.3 1.6

Table 32B. Primary and secondary syphilis — Rates per 100,000 population by race/ethnicity, age group and sex:

United States, 2001–2005

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 31 for age-specific cases and rates and Tables 24-26 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were

specified. Differences between total rates from this table and others in the report are due to different reporting formats and above listed exclusion. The 0 to 9 year

age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
128 Syphilis Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 192 211 140 231 184 4.3 4.7 3.1 5.1 4.1

Alaska 0 1 0 1 8 0.0 0.2 0.0 0.2 1.2

Arizona 266 200 232 219 134 5.0 3.7 4.2 3.8 2.3

Arkansas 60 51 71 56 48 2.2 1.9 2.6 2.0 1.7

California 408 716 820 873 1,153 1.2 2.0 2.3 2.4 3.2

Colorado 14 22 20 24 27 0.3 0.5 0.4 0.5 0.6

Connecticut 20 13 13 16 19 0.6 0.4 0.4 0.5 0.5

Delaware 18 9 11 25 9 2.3 1.1 1.3 3.0 1.1

Florida 947 949 988 856 726 5.8 5.7 5.8 4.9 4.2

Georgia 703 701 720 333 380 8.4 8.2 8.3 3.8 4.3

Hawaii 7 21 6 3 4 0.6 1.7 0.5 0.2 0.3

Idaho 0 4 8 26 13 0.0 0.3 0.6 1.9 0.9

Illinois 386 528 350 322 397 3.1 4.2 2.8 2.5 3.1

Indiana 120 53 58 45 42 2.0 0.9 0.9 0.7 0.7

Iowa 6 8 5 12 6 0.2 0.3 0.2 0.4 0.2

Kansas 18 13 19 12 18 0.7 0.5 0.7 0.4 0.7

Kentucky 38 49 43 24 23 0.9 1.2 1.0 0.6 0.6

Louisiana 194 183 197 316 252 4.3 4.1 4.4 7.0 5.6

Maine 3 1 7 0 2 0.2 0.1 0.5 0.0 0.2

Maryland 362 181 211 213 289 6.7 3.3 3.8 3.8 5.2

Massachusetts 64 95 136 96 105 1.0 1.5 2.1 1.5 1.6

Michigan 368 255 122 121 69 3.7 2.5 1.2 1.2 0.7

Minnesota 16 23 45 21 46 0.3 0.5 0.9 0.4 0.9

Mississippi 329 149 173 130 162 11.5 5.2 6.0 4.5 5.6

Missouri 33 51 46 58 108 0.6 0.9 0.8 1.0 1.9

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 1 0 1 0 2 0.1 0.0 0.1 0.0 0.1

Nevada 7 12 35 24 64 0.3 0.6 1.6 1.0 2.7

New Hampshire 2 1 4 0 0 0.2 0.1 0.3 0.0 0.0

New Jersey 234 220 326 344 289 2.7 2.6 3.8 4.0 3.3

New Mexico 18 23 53 69 53 1.0 1.2 2.8 3.6 2.8

New York 566 756 1,019 744 1,084 3.0 3.9 5.3 3.9 5.6

North Carolina 483 333 261 261 215 5.9 4.0 3.1 3.1 2.5

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 100 84 92 184 136 0.9 0.7 0.8 1.6 1.2

Oklahoma 121 124 77 62 64 3.5 3.5 2.2 1.8 1.8

Oregon 9 18 27 29 16 0.3 0.5 0.8 0.8 0.4

Pennsylvania 260 237 216 183 204 2.1 1.9 1.7 1.5 1.6

Rhode Island 1 9 7 15 5 0.1 0.8 0.7 1.4 0.5

South Carolina 394 202 180 204 222 9.7 4.9 4.3 4.9 5.3

South Dakota 0 0 3 0 0 0.0 0.0 0.4 0.0 0.0

Tennessee 553 390 228 206 203 9.6 6.7 3.9 3.5 3.4

Texas 964 1,149 1,065 1,069 1,013 4.5 5.3 4.8 4.8 4.5

Utah 0 8 7 5 7 0.0 0.3 0.3 0.2 0.3

Vermont 1 0 0 0 0 0.2 0.0 0.0 0.0 0.0

Virginia 133 94 74 108 148 1.8 1.3 1.0 1.4 2.0

Washington 19 23 36 51 63 0.3 0.4 0.6 0.8 1.0

West Virginia 1 1 2 9 3 0.1 0.1 0.1 0.5 0.2

Wisconsin 43 66 54 55 58 0.8 1.2 1.0 1.0 1.1

Wyoming 0 0 1 0 0 0.0 0.0 0.2 0.0 0.0

U.S. TOTAL* 8,701 8,429 8,361 7,768 8,176 3.0 2.9 2.9 2.6 2.8

Northeast 1,151 1,332 1,728 1,398 1,708 2.1 2.5 3.2 2.6 3.1

Midwest 1,091 1,081 795 830 882 1.7 1.7 1.2 1.3 1.3

South 5,711 4,968 4,593 4,216 4,044 5.6 4.8 4.4 4.0 3.8

West 748 1,048 1,245 1,324 1,542 1.2 1.6 1.9 2.0 2.3

Guam 2 3 1 0 0 1.3 1.9 0.6 0.0 0.0

Puerto Rico 600 702 748 353 435 15.6 18.2 19.3 9.1 11.2

Virgin Islands 8 1 6 8 7 7.3 0.9 5.5 7.4 6.4

OUTLYING AREAS 610 706 755 361 442 14.9 17.1 18.2 8.7 10.6

TOTAL 9,311 9,135 9,116 8,129 8,618 3.2 3.1 3.1 2.7 2.9

Table 33. Early latent syphilis — Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.
STD Surveillance 2005 Syphilis Tables 129

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 585 614 281 314 NA 12.9 13.3 6.0 6.7

Austin-Round Rock, TX 38 25 42 59 59 2.9 1.9 3.0 4.2 4.2

Baltimore-Towson, MD NA 151 189 167 211 NA 5.8 7.2 6.3 8.0

Birmingham-Hoover, AL 45 33 24 42 82 4.2 3.1 2.2 3.9 7.6

Boston-Cambridge-Quincy, MA-NH NA 81 117 70 84 NA 1.8 2.6 1.6 1.9

Buffalo-Cheektowaga-Tonawanda, NY NA 2 2 4 3 NA 0.2 0.2 0.3 0.3

Charlotte-Gastonia-Concord, NC-SC 100 49 51 58 71 7.3 3.5 3.5 3.9 4.8

Chicago-Naperville-Joliet, IL-IN-WI NA 510 344 322 395 NA 5.5 3.7 3.4 4.2

Cincinnati-Middletown, OH-KY-IN 2 1 0 8 13 0.1 0.0 0.0 0.4 0.6

Cleveland-Elyria-Mentor, OH 39 13 7 33 21 1.8 0.6 0.3 1.5 1.0

Columbus, OH 35 55 44 72 41 2.1 3.3 2.6 4.3 2.4

Dallas-Fort Worth-Arlington, TX 334 508 488 380 381 6.2 9.3 8.7 6.7 6.7

Denver-Aurora, CO 13 19 17 22 22 0.6 0.8 0.7 0.9 0.9

Detroit-Warren-Livonia, MI 350 228 112 103 59 7.8 5.1 2.5 2.3 1.3

Hartford-West Hartford-East Hartford, CT 7 7 2 5 7 0.6 0.6 0.2 0.4 0.6

Houston-Baytown-Sugar Land, TX 212 198 237 246 207 4.4 4.0 4.7 4.7 4.0

Indianapolis, IN 85 31 23 24 19 5.5 2.0 1.4 1.5 1.2

Jacksonville, FL 55 27 40 75 56 4.8 2.3 3.3 6.1 4.6

Kansas City, MO-KS 4 12 31 23 51 0.2 0.6 1.6 1.2 2.6

Las Vegas-Paradise, NV 6 7 28 19 57 0.4 0.5 1.8 1.2 3.5

Los Angeles-Long Beach-Santa Ana, CA NA 390 434 445 666 NA 3.1 3.4 3.4 5.2

Louisville, KY-IN 24 36 34 16 16 2.0 3.0 2.9 1.3 1.3

Memphis, TN-MS-AR 401 239 177 170 171 32.9 19.4 14.3 13.6 13.7

Miami-Fort Lauderdale-Miami Beach, FL 393 516 578 477 302 7.7 9.9 10.9 8.9 5.6

Milwaukee-Waukesha-West Allis, WI NA 53 41 37 36 NA 3.5 2.7 2.4 2.4

Minneapolis-St. Paul-Bloomington, MN-WI NA 23 41 19 43 NA 0.8 1.3 0.6 1.4

Nashville-Davidson-Murfreesboro, TN 150 127 31 30 29 11.2 9.4 2.3 2.1 2.1

New Orleans-Metairie-Kenner, LA NA 45 48 85 68 NA 3.4 3.6 6.4 5.2

New York-Newark-Edison, NY-NJ-PA NA 903 1,259 1,012 1,281 NA 4.9 6.8 5.4 6.8

Oklahoma City, OK 90 81 62 47 36 8.1 7.2 5.5 4.1 3.1

Orlando, FL 269 172 117 90 124 15.8 9.8 6.5 4.8 6.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 263 256 220 171 NA 4.6 4.4 3.8 2.9

Phoenix-Mesa-Scottsdale, AZ NA NA 165 165 97 NA NA 4.6 4.4 2.6

Pittsburgh, PA NA 15 11 8 28 NA 0.6 0.5 0.3 1.2

Portland-Vancouver-Beaverton, OR-WA 8 19 22 23 12 0.4 0.9 1.1 1.1 0.6

Providence-New Bedford-Fall River, RI-MA NA 12 11 25 10 NA 0.7 0.7 1.5 0.6

Richmond, VA 38 17 24 18 24 3.4 1.5 2.1 1.6 2.1

Riverside-San Bernardino-Ontario, CA NA 43 34 40 64 NA 1.2 0.9 1.1 1.7

Rochester, NY NA 2 8 4 13 NA 0.2 0.8 0.4 1.2

Sacramento-Arden-Arcade-Roseville, CA NA 8 5 11 11 NA 0.4 0.3 0.5 0.5

Salt Lake City, UT 0 7 4 5 3 0.0 0.7 0.4 0.5 0.3

San Antonio, TX 123 108 66 79 144 7.0 6.0 3.6 4.3 7.8

San Diego-Carlsbad-San Marcos, CA NA 34 41 84 117 NA 1.2 1.4 2.9 4.0

San Francisco-Oakland-Fremont, CA NA 203 230 235 220 NA 4.9 5.5 5.7 5.3

San Jose-Sunnyvale-Santa Clara, CA NA 11 20 13 18 NA 0.6 1.2 0.7 1.0

Seattle-Tacoma-Bellevue, WA 15 18 30 42 60 0.5 0.6 1.0 1.3 1.9

St. Louis, MO-IL 36 40 28 31 34 1.3 1.5 1.0 1.1 1.2

Tampa-St. Petersburg-Clearwater, FL 58 80 142 103 101 2.4 3.2 5.6 4.0 3.9

Virginia Beach-Norfolk-Newport News, VA-NC 47 35 21 45 78 3.0 2.2 1.3 2.7 4.7

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 243 195 182 208 NA 4.8 3.8 3.5 4.0

U.S. MSA TOTAL 2,977 6,285 6,547 5,774 6,338 4.9 4.2 4.2 3.7 4.0

Table 34. Early latent syphilis — Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
130 Syphilis Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 380 334 309 232 193 8.5 7.4 6.9 5.1 4.3

Alaska 9 8 7 6 5 1.4 1.2 1.1 0.9 0.8

Arizona 672 666 659 572 455 12.7 12.2 11.8 10.0 7.9

Arkansas 124 124 172 142 124 4.6 4.6 6.3 5.2 4.5

California 2,038 2,107 2,024 2,293 2,527 5.9 6.0 5.7 6.4 7.0

Colorado 111 86 82 90 70 2.5 1.9 1.8 2.0 1.5

Connecticut 131 147 163 108 88 3.8 4.2 4.7 3.1 2.5

Delaware 47 42 29 26 15 5.9 5.2 3.5 3.1 1.8

Florida 1,446 1,686 1,610 1,364 1,422 8.8 10.1 9.5 7.8 8.2

Georgia 850 743 836 701 898 10.1 8.7 9.6 7.9 10.2

Hawaii 22 27 39 25 42 1.8 2.2 3.1 2.0 3.3

Idaho 10 11 18 25 21 0.8 0.8 1.3 1.8 1.5

Illinois 706 546 633 614 663 5.6 4.3 5.0 4.8 5.2

Indiana 245 196 252 164 182 4.0 3.2 4.1 2.6 2.9

Iowa 33 38 29 19 13 1.1 1.3 1.0 0.6 0.4

Kansas 43 44 32 49 51 1.6 1.6 1.2 1.8 1.9

Kentucky 104 72 83 79 54 2.6 1.8 2.0 1.9 1.3

Louisiana 426 439 1,195 979 696 9.5 9.8 26.6 21.7 15.4

Maine 12 6 6 5 3 0.9 0.5 0.5 0.4 0.2

Maryland 305 415 443 399 387 5.7 7.6 8.0 7.2 7.0

Massachusetts 334 346 375 307 168 5.2 5.4 5.8 4.8 2.6

Michigan 347 408 451 470 297 3.5 4.1 4.5 4.6 2.9

Minnesota 83 65 103 96 89 1.7 1.3 2.0 1.9 1.7

Mississippi 175 247 220 212 160 6.1 8.6 7.6 7.3 5.5

Missouri 110 118 96 114 114 2.0 2.1 1.7 2.0 2.0

Montana 0 4 0 0 0 0.0 0.4 0.0 0.0 0.0

Nebraska 5 19 15 8 12 0.3 1.1 0.9 0.5 0.7

Nevada 47 86 102 189 169 2.2 4.0 4.6 8.1 7.2

New Hampshire 17 15 14 21 17 1.3 1.2 1.1 1.6 1.3

New Jersey 637 637 572 319 375 7.5 7.4 6.6 3.7 4.3

New Mexico 36 48 75 97 68 2.0 2.6 4.0 5.1 3.6

New York 2,701 2,620 2,715 2,979 2,054 14.2 13.7 14.1 15.5 10.7

North Carolina 475 424 417 285 213 5.8 5.1 5.0 3.3 2.5

North Dakota 2 0 0 0 0 0.3 0.0 0.0 0.0 0.0

Ohio 115 105 189 148 153 1.0 0.9 1.7 1.3 1.3

Oklahoma 102 89 211 79 50 2.9 2.5 6.0 2.2 1.4

Oregon 26 29 43 50 52 0.7 0.8 1.2 1.4 1.4

Pennsylvania 362 342 329 273 308 2.9 2.8 2.7 2.2 2.5

Rhode Island 29 45 50 62 35 2.7 4.2 4.6 5.7 3.2

South Carolina 268 269 263 194 239 6.6 6.5 6.3 4.6 5.7

South Dakota 0 0 0 0 2 0.0 0.0 0.0 0.0 0.3

Tennessee 580 514 511 459 493 10.1 8.9 8.7 7.8 8.4

Texas 2,145 2,299 2,200 2,244 2,336 10.0 10.6 9.9 10.0 10.4

Utah 14 56 51 59 33 0.6 2.4 2.2 2.5 1.4

Vermont 4 0 0 2 0 0.7 0.0 0.0 0.3 0.0

Virginia 287 362 395 380 361 4.0 5.0 5.3 5.1 4.8

Washington 98 63 121 135 144 1.6 1.0 2.0 2.2 2.3

West Virginia 1 2 7 6 12 0.1 0.1 0.4 0.3 0.7

Wisconsin 64 38 41 43 37 1.2 0.7 0.7 0.8 0.7

Wyoming 3 1 3 3 1 0.6 0.2 0.6 0.6 0.2

U.S. TOTAL* 16,976 17,168 18,319 17,300 16,049 5.9 6.0 6.3 5.9 5.5

Northeast 4,227 4,158 4,224 4,076 3,048 7.8 7.7 7.8 7.5 5.6

Midwest 1,753 1,577 1,841 1,725 1,613 2.7 2.4 2.8 2.6 2.5

South 7,910 8,241 9,030 7,955 7,801 7.8 8.0 8.6 7.5 7.4

West 3,086 3,192 3,224 3,544 3,587 4.8 4.9 4.9 5.3 5.3

Guam 15 9 13 13 16 9.5 5.6 7.9 7.8 9.6

Puerto Rico 402 398 390 608 551 10.5 10.3 10.1 15.6 14.1

Virgin Islands 0 2 5 4 5 0.0 1.8 4.6 3.7 4.6

OUTLYING AREAS 417 409 408 625 572 10.2 9.9 9.8 15.0 13.7

TOTAL 17,393 17,577 18,727 17,925 16,621 6.0 6.0 6.3 6.0 5.6

Table 35. Late and late latent syphilis — Reported cases and rates by state/area and region listed in

alphabetical order: United States and outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.
STD Surveillance 2005 Syphilis Tables 131

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Atlanta-Sandy Springs-Marietta, GA NA 460 566 522 714 NA 10.2 12.3 11.1 15.2

Austin-Round Rock, TX 79 59 78 85 89 6.0 4.4 5.7 6.0 6.3

Baltimore-Towson, MD NA 222 229 195 209 NA 8.5 8.8 7.4 7.9

Birmingham-Hoover, AL 108 99 74 40 57 10.2 9.3 6.9 3.7 5.3

Boston-Cambridge-Quincy, MA-NH NA 312 330 256 149 NA 7.0 7.4 5.8 3.4

Buffalo-Cheektowaga-Tonawanda, NY NA 7 7 11 4 NA 0.6 0.6 1.0 0.3

Charlotte-Gastonia-Concord, NC-SC 61 66 87 45 61 4.4 4.7 6.1 3.1 4.1

Chicago-Naperville-Joliet, IL-IN-WI NA 512 630 576 611 NA 5.5 6.7 6.1 6.5

Cincinnati-Middletown, OH-KY-IN 23 24 16 24 18 1.1 1.2 0.8 1.2 0.9

Cleveland-Elyria-Mentor, OH 6 10 23 11 9 0.3 0.5 1.1 0.5 0.4

Columbus, OH 60 52 102 72 76 3.7 3.1 6.1 4.3 4.5

Dallas-Fort Worth-Arlington, TX 516 683 735 701 792 9.6 12.5 13.1 12.3 13.9

Denver-Aurora, CO 79 66 64 56 51 3.5 2.9 2.8 2.4 2.2

Detroit-Warren-Livonia, MI 296 356 383 400 238 6.6 7.9 8.5 8.9 5.3

Hartford-West Hartford-East Hartford, CT 47 50 52 28 35 4.1 4.3 4.4 2.4 3.0

Houston-Baytown-Sugar Land, TX 712 796 768 783 685 14.7 16.0 15.1 15.1 13.2

Indianapolis, IN 103 74 93 68 80 6.6 4.7 5.8 4.2 4.9

Jacksonville, FL 57 36 73 70 41 5.0 3.1 6.1 5.7 3.3

Kansas City, MO-KS 40 45 41 40 53 2.1 2.4 2.2 2.1 2.8

Las Vegas-Paradise, NV 24 67 87 167 139 1.6 4.4 5.5 10.1 8.4

Los Angeles-Long Beach-Santa Ana, CA NA 1,245 1,137 1,451 1,649 NA 9.8 8.9 11.2 12.8

Louisville, KY-IN 68 42 63 60 40 5.8 3.6 5.3 5.0 3.3

Memphis, TN-MS-AR 343 276 278 242 272 28.2 22.4 22.4 19.4 21.8

Miami-Fort Lauderdale-Miami Beach, FL 870 1,012 909 769 742 17.0 19.3 17.2 14.3 13.8

Milwaukee-Waukesha-West Allis, WI NA 24 22 28 18 NA 1.6 1.5 1.8 1.2

Minneapolis-St. Paul-Bloomington, MN-WI NA 52 89 79 74 NA 1.7 2.9 2.5 2.4

Nashville-Davidson-Murfreesboro, TN 176 172 158 145 126 13.2 12.7 11.5 10.4 9.0

New Orleans-Metairie-Kenner, LA NA 71 187 259 190 NA 5.4 14.2 19.6 14.4

New York-Newark-Edison, NY-NJ-PA NA 3,111 3,077 3,058 2,241 NA 16.7 16.5 16.3 12.0

Oklahoma City, OK 67 63 135 42 28 6.0 5.6 11.9 3.7 2.4

Orlando, FL 117 159 129 106 183 6.9 9.1 7.2 5.7 9.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD NA 345 392 361 284 NA 6.0 6.8 6.2 4.9

Phoenix-Mesa-Scottsdale, AZ NA NA 589 468 363 NA NA 16.4 12.6 9.8

Pittsburgh, PA NA 13 8 2 15 NA 0.5 0.3 0.1 0.6

Portland-Vancouver-Beaverton, OR-WA 25 19 34 35 43 1.3 0.9 1.7 1.7 2.1

Providence-New Bedford-Fall River, RI-MA NA 58 74 81 37 NA 3.6 4.6 5.0 2.3

Richmond, VA 37 59 77 56 50 3.3 5.2 6.8 4.9 4.3

Riverside-San Bernardino-Ontario, CA NA 166 184 174 208 NA 4.7 5.1 4.6 5.5

Rochester, NY NA 10 18 25 17 NA 1.0 1.7 2.4 1.6

Sacramento-Arden-Arcade-Roseville, CA NA 26 11 33 8 NA 1.3 0.6 1.6 0.4

Salt Lake City, UT 6 36 33 42 23 0.6 3.6 3.3 4.1 2.3

San Antonio, TX 175 165 109 164 178 10.0 9.2 6.0 8.8 9.6

San Diego-Carlsbad-San Marcos, CA NA 87 139 124 133 NA 3.0 4.7 4.2 4.5

San Francisco-Oakland-Fremont, CA NA 266 260 258 165 NA 6.4 6.3 6.2 4.0

San Jose-Sunnyvale-Santa Clara, CA NA 48 57 39 56 NA 2.8 3.3 2.2 3.2

Seattle-Tacoma-Bellevue, WA 70 50 74 93 100 2.3 1.6 2.4 2.9 3.2

St. Louis, MO-IL 107 84 69 85 86 3.9 3.1 2.5 3.1 3.1

Tampa-St. Petersburg-Clearwater, FL 106 177 166 110 139 4.3 7.1 6.6 4.3 5.4

Virginia Beach-Norfolk-Newport News, VA-NC 101 118 104 100 105 6.3 7.3 6.4 6.1 6.4

Washington-Arlington-Alexandria, DC-VA-MD-WV NA 483 470 511 453 NA 9.6 9.2 9.9 8.8

U.S. MSA TOTAL 4,479 12,433 13,490 13,150 12,137 7.3 8.2 8.6 8.3 7.7

Table 36. Late and late latent syphilis — Reported cases and rates in selected metropolitan statistical areas*

(MSAs) listed in alphabetical order: United States, 2001–2005

*MSAs selected based on largest population in 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow MSA-specific

case counts and rates to be determined for some jurisdictions for some years.
132 Syphilis Tables STD Surveillance 2005

Year Cases Rate per 100,000 Live Births

1963* 367 9.2

1964* 336 8.7

1965* 335 8.9

1966* 333 8.8

1967 156 4.1

1968 274 7.3

1969 264 7.0

1970 323 8.6

1971 422 11.9

1972 360 11.0

1973 295 9.4

1974 250 7.9

1975 169 5.3

1976 160 5.1

1977 134 4.0

1978 104 3.0

1979 123 3.5

1980 107 3.0

1981 160 4.4

1982 159 4.3

1983 158 4.3

1984 247 6.7

1985 266 7.1

1986 357 9.5

1987 444 11.7

1988 658 16.8

1989 1,807 44.7

1990 3,816 91.8

1991 4,410 107.3

1992 4,024 99.0

1993 3,395 84.9

1994 2,435 61.6

1995 1,862 47.7

1996 1,282 32.9

1997 1,081 27.9

1998 844 21.4

1999 579 14.6

2000 580 14.3

2001 503 12.5

2002 459 11.4

2003 432 10.6

2004 371 9.1

2005 329 8.0

Table 37. Congenital syphilis — Reported cases and rates in infants < 1 year of age: United States (excluding

outlying areas), 1963–2005

*For 1963 to 1966 data were reported for the federal fiscal year ending June 30 of the year indicated.

NOTE: The surveillance case definition for congenital syphilis changed in 1988. As of 1995, cases of congenital syphilis 1 year of age are obtained

using case reporting form CDC 73.126. For the period 1995 through 2005, yearly case counts in this table correspond to confirmed diagnoses of

congenital syphilis among those known to be less than one year of age. As a result, the case counts in this table are a subset of those listed in Table 1

for the years prior to 1995.
STD Surveillance 2005 Syphilis Tables 133

Rank* State† Cases Rate per 100,000 Live Births

1 Arizona 28 30.8

2 New Mexico 6 21.6

3 Maryland 16 21.4

4 Arkansas 7 18.5

5 Texas 65 17.2

6 Louisiana 11 16.9

7 California 75 13.9

8 New Jersey 16 13.7

9 Michigan 17 13.0

10 Illinois 23 12.6

11 North Carolina 10 8.5

12 Alabama 5 8.4

U.S. TOTAL§ 329 8.0

13 Florida 16 7.5

14 South Carolina 4 7.2

15 Missouri 3 3.9

16 Tennessee 3 3.8

17 New York 8 3.2

18 Nevada 1 3.0

19 Virginia 3 3.0

20 Wisconsin 2 2.9

21 Connecticut 1 2.3

22 Indiana 2 2.3

23 Oklahoma 1 2.0

24 Colorado 1 1.4

25 Minnesota 1 1.4

26 Ohio 2 1.3

YEAR 2010 TARGET 1.0

27 Georgia 1 0.7

28 Pennsylvania 1 0.7

Alaska 0 0.0

Delaware 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Iowa 0 0.0

Kansas 0 0.0

Kentucky 0 0.0

Maine 0 0.0

Massachusetts 0 0.0

Mississippi 0 0.0

Montana 0 0.0

Nebraska 0 0.0

New Hampshire 0 0.0

North Dakota 0 0.0

Oregon 0 0.0

Rhode Island 0 0.0

South Dakota 0 0.0

Utah 0 0.0

Vermont 0 0.0

Washington 0 0.0

West Virginia 0 0.0

Wyoming 0 0.0

Table 38. Congenital syphilis — Reported cases and rates in infants < 1 year of age by state, ranked

by rates: United States, 2005

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Mother’s state of residence used to assign case.

§

Total includes cases reported by Washington, D.C. but excludes outlying areas (Guam with 1 case and rate of 30.5, Puerto Rico with 11 cases and

rate of 21.7, and Virgin Islands with 0 cases and rate of 0.0).
134 Syphilis Tables STD Surveillance 2005

Cases Rates per 100,000 Live Births

State/Area* 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 10 6 4 11 5 16.5 10.2 6.7 18.5 8.4

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 31 20 29 26 28 36.2 22.8 31.9 28.6 30.8

Arkansas 6 10 2 4 7 16.2 26.7 5.3 10.6 18.5

California 62 61 64 66 75 11.7 11.5 11.8 12.2 13.9

Colorado 1 2 3 2 1 1.5 2.9 4.3 2.9 1.4

Connecticut 2 0 1 0 1 4.7 0.0 2.3 0.0 2.3

Delaware 0 0 0 1 0 0.0 0.0 0.0 8.8 0.0

Florida 38 28 27 16 16 18.5 13.6 12.7 7.5 7.5

Georgia 21 13 11 6 1 15.7 9.8 8.1 4.4 0.7

Hawaii 0 0 2 0 0 0.0 0.0 11.0 0.0 0.0

Idaho 0 0 4 3 0 0.0 0.0 18.3 13.8 0.0

Illinois 46 40 20 26 23 25.0 22.1 11.0 14.2 12.6

Indiana 13 9742 15.0 10.6 8.1 4.6 2.3

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 2 0 1 2 0 5.1 0.0 2.5 5.1 0.0

Kentucky 1 3 1 1 0 1.8 5.5 1.8 1.8 0.0

Louisiana 0 2 6 18 11 0.0 3.1 9.2 27.7 16.9

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 5 19 9 10 16 6.8 25.9 12.0 13.3 21.4

Massachusetts 2 1 0 0 0 2.5 1.2 0.0 0.0 0.0

Michigan 27 35 38 23 17 20.2 26.9 29.0 17.5 13.0

Minnesota 0 1 0 1 1 0.0 1.5 0.0 1.4 1.4

Mississippi 10 6230 23.7 14.5 4.7 7.1 0.0

Missouri 5 1 4 3 3 6.6 1.3 5.2 3.9 3.9

Montana 0 1 0 0 0 0.0 9.1 0.0 0.0 0.0

Nebraska 0 0 1 0 0 0.0 0.0 3.9 0.0 0.0

Nevada 0 0 0 0 1 0.0 0.0 0.0 0.0 3.0

New Hampshire 1 0 0 0 0 6.8 0.0 0.0 0.0 0.0

New Jersey 32 36 21 13 16 27.6 31.4 18.0 11.1 13.7

New Mexico 57636 18.4 25.2 21.6 10.8 21.6

New York 39 31 42 22 8 15.4 12.3 16.6 8.7 3.2

North Carolina 19 15 20 9 10 16.1 12.8 16.9 7.6 8.5

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 1 3 3 2 2 0.7 2.0 2.0 1.3 1.3

Oklahoma 52121 10.0 4.0 2.0 3.9 2.0

Oregon 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Pennsylvania 4 5 2 0 1 2.8 3.5 1.4 0.0 0.7

Rhode Island 0 0 0 1 0 0.0 0.0 0.0 7.6 0.0

South Carolina 19 15 15 10 4 34.1 27.5 27.0 18.0 7.2

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 14 10 7 9 3 17.9 12.9 8.9 11.4 3.8

Texas 75 72 77 65 65 20.5 19.3 20.4 17.2 17.2

Utah 0 0 0 1 0 0.0 0.0 0.0 2.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 3 1 1 6 3 3.0 1.0 1.0 5.9 3.0

Washington 0 2 0 0 0 0.0 2.5 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 2 1 0 1 2 2.9 1.5 0.0 1.4 2.9

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL† 503 459 432 371 329 12.5 11.4 10.6 9.1 8.0

Northeast 80 73 66 36 26 11.7 10.8 9.6 5.2 3.8

Midwest 96 90 74 62 50 10.8 10.3 8.3 7.0 5.6

South 228 203 184 172 142 15.4 13.7 12.2 11.4 9.4

West 99 93 108 101 111 10.1 9.4 10.7 10.0 11.0

Guam 11101 28.1 31.1 30.5 0.0 30.5

Puerto Rico 22 24 17 11 11 39.4 45.5 33.5 21.7 21.7

Virgin Islands 10000 59.9 0.0 0.0 0.0 0.0

OUTLYING AREAS 24 25 18 11 12 39.3 43.4 32.4 19.8 21.6

TOTAL 527 484 450 382 341 12.9 11.9 10.9 9.2 8.2

Table 39. Congenital syphilis — Reported cases and rates in infants < 1 year of age by state/area and region

listed in alphabetical order: United States and outlying areas, 2001–2005

*Mother’s state of residence used to assign case.

†

Includes cases reported by Washington, D.C.
STD Surveillance 2005 Syphilis Tables 135

Year of Birth Race/Ethnicity Cases Rate per 100,000 Live Births

2001

White/Non-Hispanic 49 2.1

Black/Non-Hispanic 262 44.2

Hispanic 164 19.3

Asian/Pacific Islander 5 2.5

Native American/Alaskan Native 8 20.5

Other 2 NA

Unknown 13 NA

Total 503 12.5

2002

White/Non-Hispanic 36 1.6

Black/Non-Hispanic 257 44.2

Hispanic 145 16.5

Asian/Pacific Islander 10 4.8

Native American/Alaskan Native 3 7.6

Other 1 NA

Unknown 7 NA

Total 459 11.4

2003

White/Non-Hispanic 35 1.5

Black/Non-Hispanic 201 34.7

Hispanic 166 18.2

Asian/Pacific Islander 14 6.5

Native American/Alaskan Native 2 5.1

Other 3 NA

Unknown 11 NA

Total 432 10.6

2004

White/Non-Hispanic 40 1.7

Black/Non-Hispanic 167 28.8

Hispanic 144 15.8

Asian/Pacific Islander 6 2.8

Native American/Alaskan Native 2 5.1

Other 1 NA

Unknown 11 NA

Total 371 9.1

2005

White/Non-Hispanic 31 1.3

Black/Non-Hispanic 150 25.9

Hispanic 122 13.4

Asian/Pacific Islander 15 7.0

Native American/Alaskan Native 5 12.7

Other 2 NA

Unknown 4 NA

Total 329 8.0

Table 40. Congenital syphilis — Reported cases and rates in infants < 1 year of age by race/ethnicity of

mother: United States, 2001–2005

NA = Not applicable
136 Chancroid Tables STD Surveillance 2005

Cases Rates per 100,000 Population

State/Area 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005

Alabama 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 0 0 2 2 1 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 2 2 0 1 1 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 2 7 2 1 1 0.0 0.0 0.0 0.0 0.0

Georgia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 0 0 0 2 0 0.0 0.0 0.0 0.1 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Indiana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 0 2 0 2 4 0.0 0.0 0.0 0.0 0.1

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 2 3 3 3 1 0.0 0.0 0.0 0.0 0.0

Michigan 0 0 0 2 0 0.0 0.0 0.0 0.0 0.0

Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 4 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Mexico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New York 3 2 10 4 1 0.0 0.0 0.1 0.0 0.0

North Carolina 3 0 2 1 5 0.0 0.0 0.0 0.0 0.1

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 0 0 0 0 1 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oregon 0 0 2 1 0 0.0 0.0 0.1 0.0 0.0

Pennsylvania 0 0 1 1 0 0.0 0.0 0.0 0.0 0.0

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

South Carolina 15 24 24 4 0 0.4 0.6 0.6 0.1 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Texas 6 5 3 3 1 0.0 0.0 0.0 0.0 0.0

Utah 1 0 2 1 0 0.0 0.0 0.1 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Washington 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Wyoming 0 0 1 0 1 0.0 0.0 0.2 0.0 0.2

U.S. TOTAL* 38 48 54 30 17 0.0 0.0 0.0 0.0 0.0

Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Puerto Rico 4 2 4 1 3 0.1 0.1 0.1 0.0 0.1

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 4 2 4 1 3 0.1 0.0 0.1 0.0 0.1

TOTAL 42 50 58 31 20 0.0 0.0 0.0 0.0 0.0

Table 41. Chancroid — Reported cases and rates by state/area listed in alphabetical order: United States and

outlying areas, 2001–2005

*Includes cases reported by Washington, D.C.
STD Surveillance 2005 Selected STDs Table 137

Table 42. Selected STDs and complications — Initial visits to physicians' offices, National Disease and

Therapeutic Index: United States, 1966–2005

*Women only.

†

Women 15-44 only. NA = Not available.

NOTE: Standard errors for estimates under 100,000 are not available. The relative standard error for estimates 100,000-300,000 are between 20%

and 30%; 300,000–600,000 are between 16% and 20%; 600,000–1,000,000 are 13% and 15%; and 1,000,000–5,000,000 are between 9% and 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health). See Appendix (Other Data Sources) for more information.

Year

Genital

Herpes

Genital

Warts

Vaginal

Trichomoniasis*

Other

Vaginitis*

Pelvic Inflammatory

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

APPENDIX
APPENDIX
Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance,

2005 presents surveillance information

derived from the official statistics for the

reported occurrence of nationally notifiable

sexually transmitted diseases in the United

States, test positivity and prevalence data

from numerous prevalence monitoring

initiatives, sentinel surveillance of

gonococcal antimicrobial resistance, and

national health care services surveys.

Nationally Notifiable STD Surveillance

Nationally notifiable STD surveillance data

are collected and compiled from reports

sent by the STD control programs and

health departments in the 50 states, the

District of Columbia, selected cities, U.S.

dependencies and possessions, and

independent nations in free association with

the United States to the Division of STD

Prevention (DSTDP), National Center for

HIV, STD, and TB Prevention (NCHSTP),

Centers for Disease Control and Prevention

(CDC). Included among the dependencies,

possessions, and independent nations are

Guam, Puerto Rico, and the Virgin Islands.

These entities are identified as “outlying

areas” of the United States in selected

figures and tables.

Reporting Formats

STD morbidity data presented in this report

are compiled from a combination of data

reported on standardized hardcopy report

forms and electronic data received via the

National Electronic Telecommunications

System for Surveillance (NETSS).

Summary Report Forms (hardcopy

format)

The following hardcopy forms were used to

report national STD morbidity data:

1. FORM CDC 73.998: Monthly

Surveillance Report of Early Syphilis. This

monthly hardcopy reporting form was used

from1984 to 2002 to report summary data

for P&S syphilis and early latent syphilis by

county and state.

2. FORM CDC 73.688: Sexually

Transmitted Disease Morbidity Report. This

quarterly hardcopy reporting form was

used from1963 to 2002 to report summary

data for all stages of syphilis, congenital

syphilis, gonorrhea, chancroid, chlamydia,

and other STDs by sex and source of report

(private vs. public) for the 50 states,

Washington, D.C., and 64 selected cities

(including San Juan, PR) and outlying

areas of the United States. Note: Genital

Chlamydia infection became a nationally

notifiable condition in 1996, and the form

was modified to support reporting of

chlamydia that year. Congenital syphilis

was dropped from this aggregate form in

1995 and replaced by the case-specific

CDC 73.126 form listed below.

3. FORM CDC 73.2638: Report of Civilian

Cases of Primary & Secondary Syphilis,

Gonorrhea, and Chlamydia by Reporting

Source, Sex, Race/Ethnicity, and Age

Group. This annual hardcopy form was

used from1981 to 2002 to report summary

data for P&S syphilis, gonorrhea, and

chlamydia by age, race, sex and source

(public vs. private) for all states and seven

large cities (Baltimore, Chicago, New York

City, Los Angeles, Philadelphia, San

STD Surveillance 2005 Appendix Interpreting STD Surveillance Data 139
Francisco, and Washington, D.C.), and

outlying areas of the United States. Note:

Genital Chlamydia infection became a

nationally notifiable condition in 1996 and

the form was modified to support reporting

of chlamydia that year.

4. FORM CDC 73.126: Congenital Syphilis

(CS) Case Investigation and Report. This

case-specific hardcopy form was first used

in 1983 and continues to be used to report

detailed case-specific data for congenital

syphilis.

National Electronic

Telecommunications System for

Surveillance (NETSS, electronic

format)

Notifiable STD data reported electronically

through NETSS comprise the nationally

notifiable disease information that is

published in the Morbidity and Mortality

Weekly Report (MMWR).

As of December 31, 2003, all 50 states and

Washington, D.C. had converted from

summary hardcopy reporting to electronic

submission of line-listed (i.e., case-specific)

STD data via NETSS. Guam, Puerto Rico

and the Virgin Islands continue to report

using summary hardcopy forms.

Jurisdictions differ in their ability to resolve

differences in total cases derived from

summary hardcopy monthly, quarterly, and

annual reports (as well as electronically

submitted line-listed data). Thus,

depending on the database used, there

may be discrepancies in the total number of

cases among the figures and tables for

earlier years. In most instances, these

discrepancies are less than 5% of total

reported cases and have minimal impact on

national case totals and rates. However, for

a specific jurisdiction, the discrepancies

may be larger.

Reports and corrections sent to CDC

on hardcopy forms and for NETSS

electronic data through May 6, 2006

have been included in this report.

Data received after this date will

appear in subsequent annual

Surveillance Reports. The data

presented in the figures and tables in

this document supersede those in all

earlier publications.

Population Denominators and Rate

Calculations

2000–2005 Rates and Population

Crude incidence rates (new

cases/population) were calculated on an

annual basis per 100,000 population. In

this report, the 2005 rates for the United

States, all states, counties, MSAs, and

outlying areas were calculated by dividing

the number of cases reported from each

area in 2005 by the estimated area-specific

2004 population (the most current detailed

population file available at time of

publication).

The National Center for Health Statistics

released bridged race population counts for

2000–2004 resident population based on

the Census 2000 counts. These estimates

resulted from bridging the 31 race

categories used in Census 2000, as

specified in the 1997 Office of Management

and Budget (OMB) standards, to the five

race/ethnicity groups specified under the

1977 OMB standards.

From 2001 to 2002, population estimates for

Guam were obtained from the Guam Bureau

of Statistics and Plans; estimates for Puerto

Rico were obtained from the Bureau of

Census; and estimates for the Virgin Islands

were obtained from the University of the

Virgin Islands. After 2002, population

estimates for all outlying areas were obtained

from the Bureau of Census web site

http://www.census.gov/ipc/www/idbprint.html.

The 2004–2005 rates for outlying areas were

calculated using the 2004 population

estimates.

140 Interpreting STD Surveillance Data Appendix STD Surveillance 2005
Due to use of the updated population data,

rates for the period 2000–2004 may be

different from prior Surveillance Reports.

1990–1999 Rates and Population

The population counts for 1990–1999

incorporated the bridged single-race

estimates of the April 1, 2000 resident

population. These files were prepared by

the U.S. Census Bureau with support from

the National Cancer Institute.

1981–1989 Rates and Population

For the United States, rates were calculated

using Bureau of the Census population

estimates for 1981 through 1989 (Bureau

of the Census; United States Population

Estimates by Age, Sex and Race:

1980–1989 [Series P-25, No. 1045];

Washington: U.S. Government Printing

Office, 1990; and United States Population

Estimates by Age, Sex and Race: 1989

[Series P-25, No. 1057]; Washington: U.S.

Government Printing Office, 1990.

1941–1980 Rates and Population

Rates for 1941–1980 are based on

population estimates from the Bureau of

Census and currently maintained by the

Division of STD Prevention.

1963–2005 Congenital Syphilis Rates and

Live Births

Rates of congenital syphilis for 1963–1988

were calculated using published live birth

data (NCHS; Vital Statistics Report, United

States, 1988 [Vol.1-Natality]). Congenital

syphilis rates for 1989–2003 were calculated

using live births from the National Center for

Health Statistics (NCHS) (Vital Statistics:

Natality Tapes 1989–2002 or Vital Statistics

Reports, United States 1999, Vol. 48

No.10-Natality). Race-specific rates for

2004–2005 were calculated using live birth

data for 2003.

Reporting Practices

Although most areas generally adhere to

the national notifiable STD case definitions

collaboratively developed by the Council of

State and Territorial Epidemiologists

(CSTE) and CDC, there may be differences

in the policies and systems for collecting

surveillance data. Thus, comparisons of

case numbers and rates between

jurisdictions should be interpreted with

caution. However, since case definitions

and surveillance activities within a given

area remain relatively stable over time,

trends should be minimally affected by

these differences. In many areas, the

reporting from publicly supported

institutions (e.g., STD clinics) has been

more complete than from other sources

(e.g., private practitioners). Thus, trends

may not be representative of all segments

of the population.

Reporting of Metropolitan Statistical

Area-specific Surveillance Data

Sexually Transmitted Disease Surveillance,

2005 introduces the presentation of STD

incidence data and rates for the fifty

Metropolitan Statistical Areas (MSAs) with

the largest populations based on 2000 U.S.

Census data. Prior Sexually Transmitted

Disease Surveillance reports presented data

by selected cities which estimated

city-specific morbidity and were derived

from county data. Since county data were

used to estimate city-specific morbidity and

current STD project areas’ reporting

practices do not support direct identification

of city-specific morbidity reports, MSAs

(described below) were chosen as a

geographic unit smaller than a state or

territory for presentation of STD morbidity

data.

Metropolitan Statistical Areas are defined

by the Office of Management and Budget

to provide nationally consistent definitions

for collecting, tabulating, and publishing

federal statistics for a set of geographic

STD Surveillance 2005 Appendix Interpreting STD Surveillance Data 141
areas.1 An MSA is associated with at least

one urbanized area that has a population of

at least 50,000. The MSA comprises the

central county or counties containing the

core, plus adjacent outlying counties having

a high degree of social and economic

integration with the central county as

measured through commuting. The title of

an MSA includes the name of its principal

city with the largest Census 2000

population. If there are multiple principal

cities, the names of the second largest and

third largest principal cities appear in the

title in order of descending population size.

The MSA concept has been used as a

statistical representation of the social and

economic linkages between urban cores

and outlying, integrated areas. However,

MSAs do not equate to an urban-rural

classification; all counties included in MSAs

and many other counties contain both

urban and rural territory and populations.

Programs that treat all parts of an MSA as if

they were as urban as the densely settled

core ignore the rural conditions that may

exist in some parts of the area. In short,

MSAs are not designed as a general

purpose geographic framework for

nonstatistical activities or for use in

program funding formulas.

Management of Unknown, Missing or

Invalid Age Group, Race/Ethnicity,

and Sex Data

The percentage of unknown, missing or

invalid data for age group, race/ethnicity, and

sex varies from year to year, state to state,

and by disease for reported STDs (Table A1).

When the percentage of unknown, missing,

or invalid data for the variables - age group,

race/ethnicity, and sex - exceeds 50% for any

state, the state’s incidence data and

population data are excluded from the tables

presenting data stratified by one or more of

these variables (e.g. Table A1). For those

states reporting > 50% valid data for these

variables, unknown, missing or invalid data

are redistributed based on the state’s

distribution of known age group,

race/ethnicity, and sex data, respectively. As

a result of this procedure, incidence and

rate data stratified by one or more of the

variables - age group, race/ethnicity, and

sex – may not accurately reflect total

national incidence or rates.

Classification of STD Morbidity

Reporting Sources

Prior to 1996, states classified the source of

case reports as either private source

(including private physicians, and private

hospitals and institutions) or public (clinic)

source (primarily STD clinics). As states

began reporting morbidity data

electronically in 1996, the classification

categories for source of case reports

expanded to include the following data

sources: STD clinics, HIV counseling and

testing sites, drug treatment clinics, family

planning clinics, prenatal/obstetrics clinics,

tuberculosis clinics, private

physicians/HMOs, hospitals (inpatient),

emergency rooms, correctional facilities,

laboratories, blood banks, National Job

Training Program, school-based clinics,

mental health providers, military, and other

unspecified sources. Limited data analysis

of the data reported electronically after

1996 confirmed that the new STD clinic

source of report data corresponded to the

earlier reporting source category, public

(clinic) source. Therefore, source of case

report data for the period 1984–2005 are

presented as STD clinic or non-STD clinic

only (Table A2).

Definition of DHHS Regions

The ten U.S. Department of Health and

Human Services (DHHS) regions referred

to in the text and figures include the

following jurisdictions: Region I =

Connecticut, Maine, Massachusetts, New

Hampshire, Rhode Island, and Vermont;

Region II = New Jersey, New York, Puerto

Rico, and U.S. Virgin Islands; Region III =

Delaware, District of Columbia, Maryland,

142 Interpreting STD Surveillance Data Appendix STD Surveillance 2005
Pennsylvania, Virginia, and West Virginia;

Region IV = Alabama, Florida, Georgia,

Kentucky, Mississippi, North Carolina,

South Carolina, and Tennessee; Region V

= Illinois, Indiana, Michigan, Minnesota,

Ohio, and Wisconsin; Region VI =

Arkansas, Louisiana, New Mexico,

Oklahoma, and Texas; Region VII = Iowa,

Kansas, Missouri, and Nebraska; Region

VIII = Colorado, Montana, North Dakota,

South Dakota, Utah, and Wyoming; Region

IX = Arizona, California, Guam, Hawaii,

and Nevada; and Region X = Alaska,

Idaho, Oregon, and Washington.

Chlamydia Morbidity Reporting

Trends in chlamydia morbidity reporting

from many areas are more reflective of

changes in diagnosis, screening, and

reporting practices than of actual trends in

disease incidence. As areas develop

chlamydia prevention and control

programs, including improved surveillance

systems to monitor trends, the data should

improve and become more representative

of true trends in disease.

Syphilis Morbidity Reporting

“Total syphilis” or “all stages of syphilis”

includes primary, secondary, early latent,

late, late latent (including neurosyphilis, late

latent, late with clinical manifestations, and

latent syphilis of unknown duration), and

congenital syphilis.

In 1996, the syphilis stage, “late syphilis

with clinical manifestations other than

neurosyphilis (late benign and

cardiovascular syphilis)”, was added to the

syphilis case definition (see STD Case

Definitions in this Appendix).

Congenital Syphilis Morbidity

Reporting

In 1988, the surveillance case definition for

congenital syphilis was changed. This case

definition has greater sensitivity than the

former definition.2 In addition, many areas

have greatly enhanced active case finding

for congenital syphilis since 1988. For these

reasons, the number of reported cases

increased dramatically during 1989–1991.

All reporting areas had implemented the

new case definition for reporting congenital

syphilis by January 1, 1992.

In addition to changing the case definition

for congenital syphilis, CDC introduced a

new data collection form (CDC 73.126) in

1990 (revised October 2003). Since 1995,

the data collected on this form have been

used for congenital syphilis reported cases

and associated rates. This form is used to

collect individual case information which

allows more thorough analysis of case

characteristics. For the purpose of

analyses by race/ethnicity, if either the

race or ethnicity question was answered,

the case was included. For example, if

“white” race was marked, but ethnicity

was left blank, the individual was counted

as “non-Hispanic white”. Congenital

syphilis cases were reported by state and

city of residence of the mother for the

period 1995 through 2005.

Chlamydia, Gonorrhea, and Syphilis

Prevalence Monitoring

Chlamydia and gonorrhea test positivity

and syphilis seroreactivity were calculated

for the following: women attending family

planning clinics and prenatal clinics, men

and women entering the National Job

Training Program, men attending STD

clinics and primary care clinics participating

in the MSM Prevalence Monitoring Project,

and men and women entering corrections

facilities. Positivity was calculated by

dividing the number of positive tests for

chlamydia, gonorrhea, or syphilis

(numerator) by the total number of positive

and negative tests for each disease

(denominator) and was expressed as a

percentage. Except for the National Job

Training Program screening data, these

data sources may include more than one

STD Surveillance 2005 Appendix Interpreting STD Surveillance Data 143
test from the same individual if that person

was tested more than once during a year.

To increase the stability of the annual

National Job Training Program prevalence

estimates, chlamydia or gonorrhea

prevalence data are presented when valid

test results for 100 or more students per

year are available for the population

subgroup and state. The majority of the

National Job Training Program's chlamydia

screening tests are tested by a single

national contract laboratory which provides

those data to CDC. Gonorrhea screening

tests for male and female students in many

training centers are tested by local

laboratories; these data are not available to

CDC. To insure that state-specific

gonorrhea screening data presented here

are representative of all students entering

training centers, gonorrhea tests results for

students at centers submitting specimens to

the national contract laboratory are

included only if the number of gonorrhea

tests submitted is greater than 90% of the

number of chlamydia tests submitted from

the same center for the same time period.

Various laboratory test methods were used

for all of these data sources except the

National Job Training Program. For most of

the figures presenting test positivity or

prevalence data, no adjustments of test

positivity based on laboratory test type and

sensitivity were made. However, for Figure

10 and Figure J, the chlamydia test results

for each test type were weighted to reflect

the sensitivity of the test used.3 The weights

used in this adjustment are the reciprocals

of the sensitivities of the laboratory test

methods used. These test type-specific

sensitivities were estimates derived from

published evaluations of chlamydia

screening tests.4,5 Limitations of this

adjustment include: unknown dates when

laboratories changed tests, missing

information on the test method, variation of

test sensitivity within a technology type,

and no adjustment for supplemental testing

such as negative grey zone testing.

For more details on chlamydia prevalence,

refer to the following annual publication:

Centers for Disease Control and

Prevention. Sexually Transmitted Disease

Surveillance 2005 Supplement: Chlamydia

Prevalence Monitoring Project Annual

Report 2005. Atlanta, GA: U.S. Department

of Health and Human Services (available

first quarter 2007).

In the MSM Prevalence Monitoring Project

the syphilis seroreactivity data in most

instances do not reflect confirmatory testing

and thus biologic false positive test results

were not systematically excluded. The

extent to which these data reflect

prevalence of active syphilis infection varies

by site. Similarly, in the Corrections

Prevalence Monitoring Project, syphilis

seroreactivity test results were not

confirmed. Only a few juvenile corrections

sites submitted data to CDC, making

overall interpretation difficult due to the

small sample size. Because only selected

corrections facilities participated in the

Corrections Prevalence Monitoring Project,

state-specific positivity for syphilis,

chlamydia, and gonorrhea may not be

representative of all corrections facilities in

the state.

Prevalence data for region- and

state-specific figures were published with

permission from the Regional Infertility

Prevention Program, selected state STD

prevention programs, and the National Job

Training Program.

Gonococcal Isolate Surveillance

Project (GISP)

Data on antimicrobial susceptibility in

Neisseria gonorrhoeae were collected

through the Gonococcal Isolate

Surveillance Project (GISP), a sentinel

system of 27 STD clinics and five regional

laboratories located throughout the United

States. For more details on findings from

GISP gonorrhea surveillance activities, refer

to the following annual publication: Centers

144 Interpreting STD Surveillance Data Appendix STD Surveillance 2005
for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance

2005 Supplement: Gonococcal Isolate

Surveillance Project (GISP) Annual Report

2005. Atlanta, GA: U.S. Department of

Health and Human Services (available first

quarter 2007).

Other Surveillance Data Sources

National Disease and Therapeutic Index

(NDTI)

The information on the number of initial

visits to private physicians’ offices for

sexually transmitted diseases was based on

analysis of data from the National Disease

and Therapeutic Index (NDTI)

(machine-readable files or summary

statistics for the period 1966 through 2005).

The NDTI is a probability sample survey of

private physicians’ clinical management

practices. For more information on this

database, contact IMS Health, 660 W.

Germantown Pike, Plymouth Meeting, PA

19462; Telephone: (800) 523-5333.

National Hospital Discharge Survey

(NHDS)

The information on patients hospitalized for

pelvic inflammatory disease or ectopic

pregnancy was based on analysis of data

from the National Hospital Discharge

Survey (machine-readable files for years

1980–2004), an ongoing nationwide

sample survey of medical records of

patients discharged from acute care

hospitals in the United States, conducted by

the National Center for Health Statistics.

For more information, see Graves EJ; 1988

Summary: National Hospital Discharge

Survey; Advance data No. 185; Hyattsville

(MD): National Center for Health Statistics,

1990.

National Hospital Ambulatory Medical

Care Survey (NHAMCS-ER)

The National Hospital Ambulatory Medical

Care Survey (NHAMCS-ER)

(machine-readable files for 1995–2004)

was used to obtain estimates of the number

of emergency room visits for pelvic

inflammatory disease among women ages

15 to 44 years. The estimates generated

using these data sources (NHDS and

NHAMCS-ER) are based on statistical

surveys and therefore have sampling

variability associated with the estimates.

Healthy People 2010 Objectives

Healthy People 20106 is a set of health

objectives for the U.S. to achieve over the

first decade of the new century. It is used by

people, States, communities, professional

organizations, and others to help develop

programs to improve health. Healthy

People 2010 (HP2010) builds on initiatives

pursued over the past two decades. The

1979 Surgeon General’s Report, Healthy

People, and Healthy People 2000: National

Health Promotion and Disease Prevention

Objectives established national health

objectives and served as the basis for the

development of State and community

plans. Like its predecessors, Healthy People

2010 was developed through a broad

consultation process, built on the best

scientific knowledge and designed to

measure programs over time. Healthy

People 2010 is organized into 28 focus

areas, each with objectives and measures

designed to drive action that will support

two overarching goals: 1) increasing the

quality and years of healthy life and 2)

eliminating health disparities.

Focus area 25 of Healthy People 2010 -

Sexually Transmitted Diseases, - contains

objectives and measures related to STDs.

The baselines, HP2010 targets and annual

progress toward the targets are reported in

Table A3. The year 2010 targets for the

diseases addressed in this report are:

STD Surveillance 2005 Appendix Interpreting STD Surveillance Data 145
primary and secondary syphilis–0.2 case

per 100,000 population; congenital

syphilis–1.0 case per 100,000 live births;

and gonorrhea–19.0 cases per 100,000

population. An additional target established

in the HP2010 objectives is to reduce the

Chlamydia trachomatis test positivity to 3%

among females aged 15-24 years who

attend family planning and STD clinics and

among males aged 15- 24 who attend STD

clinics.

Government Performance and

Results Act of 1993 (GPRA) Goals

The Government Performance and Results

Act of 1993 (GPRA) was enacted by

Congress to increase the confidence of

citizens in the capability of the federal

government, to increase the effectiveness

and accountability of federal programs, to

improve service delivery, to provide

agencies a uniform tool for internal

management and to assist Congressional

decision making. GPRA requires each

agency to have a performance plan with

long-term outcomes and annual, measurable

performance goals and to report on these

plans annually, comparing results with

annual goals. There are two STD GPRA

goals: 1) reduction in pelvic inflammatory

disease (PID) and 2) elimination of syphilis.

Each of these goals has measures. The

long-term goals and measures of progress are

reported in Table A4.

146 Interpreting STD Surveillance Data Appendix STD Surveillance 2005

1 Office of Management and Budget. Standards

for Defining Metropolitan and Micropolitan

Statistical Areas: Notice Federal Register

December 27, 2000; 65(249): 82228-38

2 Kaufman RE, Jones OG, Blount JH, Wiesner

PJ. Questionnaire survey of reported early

congenital syphilis: problems in diagnosis,

prevention, and treatment. Sexually Transmitted

Diseases 1977;4:135-9.

3 Webster Dicker L, Mosure DJ, Levine WC,

Black CM, Berman SM. The impact of switching

laboratory tests on reported trends in Chlamydia

trachomatis infections. Am J Epidemiol

2000;151:430-435.

4 Newhall WJ, DeLisle S, Fine D, et al.

Head-to-head evaluation of five different

non-culture chlamydia tests relative to a

quality-assured culture standard. Sexually

Transmitted Diseases 1994;21:S165-6.

5 Black CM, Marrazzo J, Johnson RE, et al.

Head-to-head multicenter comparision of DNA

probe and nucleic acid amplification tests for

Chlamydia trachomatis infection in women

performed with an improved reference

standard. J Clin Micro 2002;40:3757-3763.

6 U.S. Department of Health and Human

Services. Healthy People 2010 2ndnd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.
*Percentages for P&S syphilis are based on less than 10 cases.

†

Includes cases reported by Washington, D.C.

NOTE: "Unknown" includes unknown, missing, or invalid data values.

STD Surveillance 2005 Appendix Percentage Unknown 147

Primary and Secondary Syphilis Gonorrhea Chlamydia

State

Percent

Unknown

Race/Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Race/Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Race/Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Alabama 3.0 0.6 0.0 23.4 0.8 0.2 31.3 0.7 0.4

Alaska* 0.0 0.0 0.0 0.2 0.0 0.0 0.3 0.0 0.0

Arizona 0.0 0.0 0.6 21.0 0.0 0.1 23.9 0.0 0.0

Arkansas 0.0 0.0 0.0 3.6 0.8 0.0 1.9 0.6 0.0

California 2.3 0.0 0.1 32.5 0.6 0.5 32.8 0.6 0.5

Colorado 8.7 0.0 0.0 30.4 0.1 0.0 54.1 0.7 0.0

Connecticut 0.0 0.0 0.0 28.5 0.8 0.0 35.3 1.2 0.0

Delaware 0.0 0.0 0.0 1.4 0.0 0.0 2.1 0.0 0.0

Florida 2.1 0.0 0.0 4.4 0.2 0.0 6.1 0.1 0.0

Georgia 2.5 0.2 0.0 38.1 1.5 1.0 50.5 1.2 1.3

Hawaii 0.0 0.0 0.0 50.7 0.2 0.0 52.0 0.1 0.0

Idaho 15.0 0.0 0.0 24.4 0.0 1.7 24.9 0.3 0.8

Illinois 3.6 0.0 0.0 15.6 0.1 0.0 18.2 0.1 0.0

Indiana 8.1 0.0 0.0 13.0 0.4 0.3 15.8 0.6 0.5

Iowa* 11.1 0.0 0.0 17.4 0.4 0.0 24.0 0.6 0.0

Kansas 0.0 0.0 0.0 21.9 0.1 0.0 29.2 0.1 0.0

Kentucky 0.0 1.9 0.0 18.2 0.2 0.2 23.7 0.3 0.3

Louisiana 2.2 0.0 0.0 10.9 0.5 0.7 17.8 0.6 1.4

Maine* 0.0 0.0 0.0 9.2 0.0 0.0 19.7 0.4 0.2

Maryland 0.3 0.0 0.0 24.4 0.3 0.1 43.0 0.4 0.1

Massachusetts 0.8 0.0 0.0 31.4 0.4 0.0 37.2 0.4 0.1

Michigan 1.9 1.0 0.0 48.7 0.4 0.3 47.4 0.5 0.3

Minnesota 1.4 0.0 0.0 17.8 0.0 0.0 19.2 0.0 0.0

Mississippi 2.0 0.0 0.0 14.3 0.3 0.0 14.8 0.2 0.0

Missouri 0.0 0.0 0.0 18.9 0.1 0.0 24.0 0.1 0.0

Montana* 28.6 0.0 0.0 19.6 0.6 0.0 17.3 0.5 0.2

Nebraska* 0.0 0.0 0.0 18.8 2.2 0.3 19.7 2.8 0.1

Nevada 9.2 0.0 0.0 31.5 0.2 0.1 36.8 0.2 0.1

New Hampshire 12.5 0.0 0.0 15.3 0.0 0.0 10.2 0.0 0.0

New Jersey 4.5 0.0 0.0 44.1 1.2 0.0 50.1 1.1 0.0

New Mexico 1.8 0.0 0.0 4.0 1.0 0.0 4.9 2.1 0.0

New York 36.3 0.0 0.0 41.2 0.6 0.0 44.7 0.5 0.0

North Carolina 0.4 0.0 0.0 1.0 0.0 0.0 1.1 0.0 0.0

North Dakota* 0.0 0.0 0.0 11.7 0.0 0.0 13.0 0.7 0.1

Ohio 1.4 0.5 0.0 34.4 1.5 1.7 41.3 1.7 3.1

Oklahoma 0.0 0.0 0.0 1.0 0.0 0.0 1.7 0.0 0.0

Oregon 4.9 0.0 0.0 15.1 0.0 0.0 14.1 0.0 0.0

Pennsylvania 8.5 0.0 0.0 22.1 0.4 0.0 23.4 0.3 0.0

Rhode Island 0.0 0.0 0.0 3.4 0.2 0.0 25.6 0.1 0.2

South Carolina 0.0 0.0 0.0 24.6 1.0 0.4 31.8 0.7 0.2

South Dakota* 0.0 0.0 0.0 0.0 1.4 0.0 0.2 0.9 0.1

Tennessee 0.0 0.0 0.0 14.6 0.2 0.0 19.2 0.1 0.1

Texas 0.0 0.0 0.0 8.2 0.2 0.1 8.6 0.2 0.1

Utah 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Vermont* 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Virginia 0.7 0.0 0.0 7.5 0.1 0.1 11.8 0.2 0.2

Washington 2.0 0.0 0.0 18.9 0.7 0.0 18.7 1.3 0.0

West Virginia* 0.0 0.0 0.0 9.1 0.4 0.0 10.6 0.6 0.0

Wisconsin 0.0 0.0 0.0 25.9 0.0 0.1 28.0 0.0 0.1

Wyoming* 0.0 0.0 0.0 5.7 1.1 0.0 3.4 1.4 0.0

U.S. TOTAL† 4.8 0.1 0.0 22.2 0.5 0.3 26.3 0.5 0.3

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values for selected demographic

variables by state and by nationally notifiable STD, 2005
148 STD Reporting Source Appendix STD Surveillance 2005

Non-STD Clinic STD Clinic Total*

Disease Male Female Total Male Female Total Male Female Total

Chlamydia 143,882 602,607 748,193 78,677 92,229 171,092 232,781 740,371 976,445

Gonorrhea 87,386 133,818 221,673 65,058 30,152 95,311 161,117 177,537 339,593

Primary Syphilis 1,220 129 1,350 817 114 931 2,073 250 2,324

Secondary Syphilis 3,811 724 4,535 1,405 349 1,755 5,310 1,089 6,400

Early Latent Syphilis 4,070 1,509 5,579 1,753 703 2,456 5,934 2,242 8,176

Late and Late Latent Syphilis† 7,253 4,586 11,848 2,304 1,648 3,953 9,710 6,329 16,049

Neurosyphilis 527 168 695 77 37 114 617 211 828

Chancroid 5 5 11 5 0 5 11 5 17

Table A2. Reported cases of sexually transmitted disease reporting source and by sex: United States, 2005

*Totals include unknown sex and reporting source.

†

Late and late latent syphilis includes cases of unknown duration, late syphilis with clinical manifestations, and neurosyphilis.

See Appendix (Classification of STD Morbidity Reporting Source).
STD Surveillance 2005 Appendix Healthy People 2010 149

HP 2010 Objectives

Baseline

Year Baseline 2001 2002 2003 2004 2005

HP 2010

Target

25-1 Reduce the proportion of adolescents and

young adults with Chlamydia trachomatis

infections

a. Females aged 15 to 24 years attending family planning clinics

1997 5.0% 5.8%* 6.0%* 6.4%* 6.9%* 6.9%* 3.0%

b. Females aged 15 to 24 years attending STD clinics

1997 12.2% 13.3%* 13.5%* 14.1%* 15.3%* 15.4%* 3.0%

c. Males aged 15 to 24 years attending STD clinics

1997 15.7% 17.0%* 17.5%* 19.3%* 20.8%* 20.5%* 3.0%

25-2 Reduce gonorrhea (cases per 100,000

population)

1997 123.0 126.8 122.0 115.2 112.4 115.6 19.0

25-3 Eliminate sustained domestic transmission

of primary and secondary syphilis (cases

per 100,000 population)

1997 3.2 2.1 2.4 2.5 2.7 3.0 0.2

25-4 Reduce the proportion of adults aged 20 to

29 years with genital herpes infection

1988-94 17.0% NA 11.0% NA NA NA 14.0%

25-6 Reduce the proportion of females aged 15

to 44 years who have ever required

treatment for pelvic inflammatory disease

(PID)

1995 8.0% NA 5.0% NA NA NA 5.0%

25-7 Reduce the proportion of childless females

with fertility problems who have had a

sexually transmitted disease or who have

required treatment for pelvic

inflammatory disease (PID)

1995 27.0% NA 22.0% NA NA NA 15.0%

25-9 Reduce congenital syphilis (cases per

100,000 live births)

1997 27.0 12.5 11.4 10.6 9.1 8.0 1.0

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status

HP 2010 Objective Data Source

25-1

25-2

25-3

25-4

25-6

25-7

25-9

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

National Survey of Family Growth (NSFG), CDC, NCHS.

National Survey of Family Growth (NSFG), CDC, NCHS.

STD Surveillance System (STDSS), CDC, NCHSTP.

*Overall positivity not adjusted for changes in laboratory test method and associated increases in test sensitivity.

NOTE: Healthy People 2010 developmental objectives are not addressed in this report.

NA=Not available.
150 GPRA Goals Appendix STD Surveillance 2005

GPRA Goals Baseline Actual Performance

Long-Term

Goal

2002 2004 2005 2010

Goal 1: Reduction in PID (as measured by initial visits to physicians in

women 15-44 years of age) 197,000 132,000 176,000 168,000

a. Prevalence of Chlamydia in high-risk women  25 years 10.1%* 9.7%* 9.2%* 8.6%*

b. Prevalence of Chlamydia in women  25 years in family planning clinics 5.6%* 6.3%* 6.3%* 4.9%*

c. Incidence of Gonorrhea/100,000 population in women 15-44 years of age 279 267 276 237

Goal 2: Elimination of Syphilis (as measured by incidence of P&S

Syphilis/100,000 population) 2.4 2.7 3.0 2.2

a. Incidence of P&S Syphilis/100,000 population - men 3.8 4.7 5.1 4.2

b. Incidence of P&S Syphilis/100,000 population - women 1.1 0.8 0.9 0.38

c. Incidence of Congenital Syphilis/100,000 live births 10.2 9.1 8.0 3.9

d. Black:white rate ratio of P&S Syphilis 8:1 5.5:1 5.4:1 3:1

GPRA Goals Data Source

1

1-a

1-b

1-c

2

2-a

2-b

2-c

2-d

National Disease and Therapeutic Index (IMS Health).

National Job Training Program.

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

STD Surveillance System (STDSS), CDC, NCHSTP.

*Median state-specific chlamydia prevalence among women was not adjusted for changes in laboratory test method and associated increases in test sensitivity.

Table A4. Government Performance Results Act (GPRA) Sexually Transmitted Diseases Goals and Measures
STD Surveillance Case Definitions

PART 1. CASE DEFINITIONS1FOR NATIONALLY NOTIFIABLE INFECTIOUS DISEASES

Chancroid (Revised 9/96)

Clinical description

A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The disease is caused by infection with Haemophilus ducreyi.

Laboratory criteria for diagnosis

• Isolation of H. ducreyi from a clinical specimen

Case classification

Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by

darkfield microscopic examination of ulcer exudate or by a serologic test for syphilis performed 7

days after onset of ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease

caused by herpes simplex virus (HSV) or a culture negative for HSV.

Confirmed: a clinically compatible case that is laboratory confirmed

Chlamydia trachomatis, Genital Infections (Revised 9/96)

Clinical description

Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute

salpingitis, or other syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal infections may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. trachomatis include lymphogranuloma venereum (see

Lymphogranuloma Venereum) and trachoma.

Laboratory criteria for diagnosis

• Isolation of C. trachomatis by culture or

• Demonstration of C. trachomatis in a clinical specimen by detection of antigen or

nucleic acid

Case classification

Confirmed: a case that is laboratory confirmed

Gonorrhea (Revised 9/96)

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis.

Infection may be asymptomatic.

Laboratory criteria for diagnosis

• Isolation of typical gram-negative, oxidase-positive diplococci (presumptive

Neisseria gonorrhoeae) from a clinical specimen, or

STD Surveillance 2005 Appendix STD Surveillance Case Definitions 151
• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or

nucleic acid, or

• Observation of gram-negative intracellular diplococci in a urethral smear obtained

from a male

Case classification

Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) a written morbidity report of gonorrhea submitted by a physician

Confirmed: a case that is laboratory confirmed

Syphilis (All Definitions Revised 9/96)

Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the following case definitions developed for surveillance purposes.

Syphilis, primary

Clinical description

A stage of infection with Treponema pallidum characterized by one or more chancres (ulcers);

chancres might differ considerably in clinical appearance.

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, direct

fluorescent antibody (DFA-TP), or equivalent methods

Case classification

Probable: a clinically compatible case with one or more ulcers (chancres) consistent with primary

syphilis and a reactive serologic test (nontreponemal: Venereal Disease Research Laboratory

[VDRL] or rapid plasma reagin [RPR]; treponemal: fluorescent treponemal antibody absorbed

[FTA-ABS] or microhemagglutination assay for antibody to T. pallidum [MHA-TP])

Confirmed: a clinically compatible case that is laboratory confirmed

Syphilis, secondary

Clinical description

A stage of infection caused by T. pallidum and characterized by localized or diffuse

mucocutaneous lesions, often with generalized lymphadenopathy. The primary chancre may still

be present.

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, DFATP,

or equivalent methods

Case classification

Probable: a clinically compatible case with a nontreponemal (VDRL or RPR) titer 4

Confirmed: a clinically compatible case that is laboratory confirmed

152 STD Surveillance Case Definitions Appendix STD Surveillance 2005
Syphilis, latent

Clinical description

A stage of infection caused by T. pallidum in which organisms persist in the body of the infected

person without causing symptoms or signs. Latent syphilis is subdivided into early, late, and unknown categories based on the duration of infection.

Case classification

Probable: no clinical signs or symptoms of syphilis and the presence of one of the following:

• No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and

a reactive treponemal test (i.e., FTA-ABS or MHA-TP)

• A past history of syphilis therapy and a current nontreponemal test titer demonstrating

fourfold or greater increase from the last nontreponemal test titer

Syphilis, early latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred within the previous 12

months, latent syphilis is classified as early latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a person who has evidence of having acquired the

infection within the previous 12 months based on one or more of the following criteria:

• Documented seroconversion or fourfold or greater increase in titer of a

nontreponemal test during the previous 12 months

• A history of symptoms consistent with primary or secondary syphilis during the

previous 12 months

• A history of sexual exposure to a partner who had confirmed or probable primary or

secondary syphilis or probable early latent syphilis (documented independently as

duration 1 year)

• Reactive nontreponemal and treponemal tests from a person whose only possible

exposure occurred within the preceding 12 months

Syphilis, late latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred  1 year previously, latent

syphilis is classified as late latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a patient who has no evidence of having acquired

the disease within the preceding 12 months (see Syphilis, early latent) and whose age and titer do

not meet the criteria specified for latent syphilis of unknown duration.

Syphilis, latent, of unknown duration

Clinical description

A subcategory of latent syphilis. When the date of initial infection cannot be established as having

occurred within the previous year and the patient’s age and titer meet criteria described below, latent syphilis is classified as latent syphilis of unknown duration.

STD Surveillance 2005 Appendix STD Surveillance Case Definitions 153
Case classification

Probable: latent syphilis (see Syphilis, latent) that does not meet the criteria for early latent syphilis, and the patient is aged 13–35 years and has a nontreponemal titer  32

Neurosyphilis

Clinical description

Evidence of central nervous system infection with T. pallidum

Laboratory criteria for diagnosis

• A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF)

Case classification

Case classification

Probable: syphilis of any stage, a negative VDRL in CSF, and both the following:

• Elevated CSF protein or leukocyte count in the absence of other known causes of

these abnormalities

• Clinical symptoms or signs consistent with neurosyphilis without other known causes

for these clinical abnormalities

Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis

Syphilis, late, with clinical manifestations other than neurosyphilis (late benign syphilis

and cardiovascular syphilis)

Clinical description

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions

of the cardiovascular system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, mouth, eye, abdominal organs, reproductive organs, lymph nodes, and skeletal

muscle) may be involved. Late syphilis usually becomes clinically manifest only after a period of

15–30 years of untreated infection.

Laboratory criteria for diagnosis

Demonstration of T. pallidum in late lesions by fluorescent antibody or special stains (although organisms are rarely visualized in late lesions)

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or

other structures with a reactive treponemal test, in the absence of other known causes of these abnormalities, and without CSF abnormalities and clinical symptoms or signs consistent with

neurosyphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with

clinical manifestations.

154 STD Surveillance Case Definitions Appendix STD Surveillance 2005
Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs  500 g and the

mother had untreated or inadequately treated* syphilis at delivery

Comment

For reporting purposes, syphilitic stillbirths should be reported as cases of congenital syphilis.

Syphilis, Congenital (Revised 9/96)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity

exists, and only severe cases are clinically apparent at birth. An infant or child (aged 2 years) may

have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child

may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).

Laboratory criteria for diagnosis

Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific

stains in specimens from lesions, placenta, umbilical cord, or autopsy material

Case classification

Probable: a condition affecting an infant whose mother had untreated or inadequately treated*

syphilis at delivery, regardless of signs in the infant, or an infant or child who has a reactive

treponemal test for syphilis and any one of the following:

• Any evidence of congenital syphilis on physical examination

• Any evidence of congenital syphilis on radiographs of long bones

• A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL)

• An elevated CSF cell count or protein (without other cause)

• A reactive fluorescent treponemal antibody absorbed—19S-IgM antibody test or IgM

enzyme-linked immunosorbent assay

Confirmed: a case that is laboratory confirmed

Comment

Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after

infancy. Signs of congenital syphilis may not be obvious, and stigmata may not yet have developed.

Abnormal values for CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in

either congenital or acquired syphilis. Findings on radiographs of long bones may help because radiographic changes in the metaphysis and epiphysis are considered classic signs of congenitally acquired syphilis. The decision may ultimately be based on maternal history and clinical judgment. In

a young child, the possibility of sexual abuse should be considered as a cause of acquired rather

than congenital syphilis, depending on the clinical picture. For reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis among infants and children as well as syphilitic

stillbirths.

*Inadequate treatment consists of any nonpenicillin therapy or penicillin administered 30 days before delivery.

STD Surveillance 2005 Appendix STD Surveillance Case Definitions 155
PART 2. CASE DEFINITIONS1

FOR NON-NOTIFIABLE INFECTIOUS DISEASES

Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

Clinical description

A condition characterized by visible, painful genital or anal lesions

Laboratory criteria for diagnosis

• Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, or

• Demonstration of virus by antigen detection technique in clinical specimens from

cervix, urethra, or anogenital lesion, or

• Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an

anogenital lesion

Case classification

Probable: a clinically compatible case (in which primary and secondary syphilis have been excluded by appropriate serologic tests and darkfield microscopy, when available) with either a diagnosis of genital herpes based on clinical presentation (without laboratory confirmation) or a history

of one or more previous episodes of similar genital lesions

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital herpes should be reported only once per patient. The first diagnosis for a patient with no

previous diagnosis should be reported.

Genital Warts (Revised 9/96)

Clinical description

An infection characterized by the presence of visible, exophytic (raised) growths on the internal or

external genitalia, perineum, or perianal region

Laboratory criteria for diagnosis

• Histopathologic changes characteristic of human papillomavirus infection in

specimens obtained by biopsy or exfoliative cytology or

• Demonstration of virus by antigen or nucleic acid detection in a lesion biopsy

Case classification

Probable: a clinically compatible case without histopathologic diagnosis and without microscopic or

serologic evidence that the growth is the result of secondary syphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital warts should be reported only once per patient. The first diagnosis for a patient with no

previous diagnosis should be reported.

Granuloma Inguinale

Clinical description

A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area

caused by infection with Calymmatobacterium granulomatis. A clinically compatible case would

have one or more painless or minimally painful granulomatous lesions in the anogenital area.

156 STD Surveillance Case Definitions Appendix STD Surveillance 2005
Laboratory criteria for diagnosis

• Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained

smears or biopsies of granulation tissue

Case classification

Confirmed: a clinically compatible case that is laboratory confirmed

Lymphogranuloma Venereum

Clinical description

Infection with L1, L2, or, L3 serovars of Chlamydia trachomatis may result in a disease characterized by genital lesions, suppurative regional lymphadenopathy, or hemorrhagic proctitis. The infection is usually sexually transmitted.

Laboratory criteria for diagnosis

• Isolation of C. trachomatis, serotype L1, L2, or L3 from clinical specimen, or

• Demonstration by immunofluorescence of inclusion bodies in leukocytes of an

inguinal lymph node (bubo) aspirate, or

• Positive microimmunofluorescent serologic test for a lymphogranuloma venereum

strain of C. trachomatis

Case classification

Probable: a clinically compatible case with one or more tender fluctuant inguinal lymph nodes or

characteristic proctogenital lesions with supportive laboratory findings of a single C. trachomatis

complement fixation titer of  64

Confirmed: a clinically compatible case that is laboratory confirmed

Mucopurulent Cervicitis (Revised 9/96)

Clinical description

Cervical inflammation that is not the result of infection with Neisseria gonorrhoeae or

Trichomonas vaginalis. Cervical inflammation is defined by the presence of one of the following

criteria:

• Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on

a white, cotton-tipped swab (positive swab test)

• Induced endocervical bleeding (bleeding when the first swab is placed in the

endocervix)

Laboratory criteria for diagnosis

• No evidence of N. gonorrhoeae by culture, Gram stain, or antigen or nucleic acid

detection, and no evidence of T. vaginalis on wet mount

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or

trichomoniasis

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from

infection with any of several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea,

trichomoniasis, and chlamydia are excluded, a clinically compatible illness should be classified as

STD Surveillance 2005 Appendix STD Surveillance Case Definitions 157
MPC. An illness in a female that meets the case definition of MPC and C. trachomatis infection

should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may be diagnosed by the presence of one of the following criteria:

• A visible abnormal urethral discharge, or

• A positive leukocyte esterase test from a male aged 60 years who does not have a

history of kidney disease or bladder infection, prostate enlargement, urogenital

anatomic anomaly, or recent urinary tract instrumentation, or

• Microscopic evidence of urethritis ( 5 white blood cells per high-power field) on a

Gram stain of a urethral smear

Laboratory criteria for diagnosis

• No evidence of N. gonorrhoeae infection by culture, Gram stain, or antigen or nucleic

acid detection

Case classification

Confirmed: a clinically compatible case in a male in whom gonorrhea is not found, either by culture,

Gram stain, or antigen or nucleic acid detection

Comment

Nongonococcal urethritis (NGU) is a clinical diagnosis of exclusion. The syndrome may result

from infection with any of several agents (see Chlamydia trachomatis, Genital Infection). If gonorrhea and chlamydia are excluded, a clinically compatible illness should be classified as NGU. An illness in a male that meets the case definition of NGU and C. trachomatis infection should be

classified as chlamydia.

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and

endocervix to the endometrium, fallopian tubes, and/or contiguous structures. In a female who has

lower abdominal pain and who has not been diagnosed as having an established cause other than

pelvic inflammatory disease (PID) (e.g., ectopic pregnancy, acute appendicitis, and functional

pain), all the following clinical criteria must be present:

• Lower abdominal tenderness, and

• Tenderness with motion of the cervix, and

• Adnexal tenderness

In addition to the preceding criteria, at least one of the following findings must also be present:

• Meets the surveillance case definition of C. trachomatis infection or gonorrhea

• Temperature  100.4 F ( 38.0 C)

• Leukocytosis  10,000 white blood cells/mm3

• Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy

158 STD Surveillance Case Definitions Appendix STD Surveillance 2005
• Pelvic abscess or inflammatory complex detected by bimanual examination or by

sonography

• Patient is a sexual contact of a person known to have gonorrhea, chlamydia, or

nongonococcal urethritis

Case classification

Confirmed: a case that meets the clinical case definition

Comment

For reporting purposes, a clinician’s report of PID should be counted as a case.

STD Surveillance 2005 Appendix STD Surveillance Case Definitions 159

1 Centers for Disease Control and Prevention.

Case definitions for infectious conditions under

public health surveillance, 1997. MMWR

1997;46(No. RR-10;1).
STD Project Directors, STD Program Managers, and State and Territorial Epidemiologists

We gratefully acknowledge the contributions of state STD project directors, STD program managers, and state and territorial

epidemiologists to this report. The persons listed were in the positions shown as of August 24, 2006.

STD Project Directors STD Program Managers State Epidemiologists

Alabama Charles H. Woernle Sandra Langston John Lofgren

Alaska Wendy Crator Donna Cecere Jay Butler

Arizona Victorio Vaz Ashraf Lasee Kenneth Komatsu (Acting)

Arkansas Gary Horton Mark Barnes Jim Phillips (acting)

California Gail Bolan Romni Neiman Gilberto Chavez

Los Angeles Peter Kerndt Mary Hayes Gilberto Chavez

San Francisco Jeffrey Klausner Wendy Wolf Gilberto Chavez

Colorado Maureen Bush Beth Dillon Ned Calonge

Connecticut James L. Hadler Heidi Jenkins James L. Hadler

Delaware James C. Welch Catherine Mosley Paula Eggers

District of Columbia Karyn Berry John Heath John Davies-Cole

Florida Russell Eggert Karla Schmitt John Middaugh

Georgia Linda Smart-Smith Russ Cantrell Susan Lance

Hawaii Peter Whiticar Roy Ohye Paul Effler

Idaho Karl Kurtz Jesus Sandoval Christine G. Hahn

Illinois Charlie Rabins Ed Renier Craig Conover (Acting)

Chicago Lora Branch Dawn Broussard Craig Conover (Acting)

Indiana Vacant Jim Beall Robert Teclaw

Iowa Julie McMahon Karen Thompson Patricia Quinlisk

Kansas Brenda Walker R. Allen Mayer Gail Hansen

Kentucky Robert Brawley David Raines Kraig Humbaugh

Louisiana Lisa Ann Longfellow Lisa Ann Longfellow Raoult Ratard

Maine Bob Woods Jennah Godo Kathleen F. Gensheimer

Maryland Barbara Conrad Vacant David Blythe

Baltimore Kima Taylor Glen Oltoff David Blythe

Massachusetts Thomas Bertrand Thomas Bertrand Alfred DeMaria

Michigan Loretta Davis-Satterla Mark A. Miller Corrine Miller

Minnesota Julia Ashley Julia Ashley Harry Hull

Mississippi Craig Thompson Craig Thompson Mills McNeill

Missouri Herbert Michael Nyla DeArmitt Bao-Ping Zhu

Montana Laurie Kops Lisa Underwood Todd A. Damrow

Nebraska Phil Medina Phil Medina Thomas J. Safranek

Nevada Richard Whitley Vacant Ishan Azzam

New Hampshire Denise Rondeau Drew Thomits Jose Montero

New Jersey Janet DeGraaf Jerry Carolina Eddy A. Bresnitz

New Mexico Daryl Smith Jaime Vega-Hernandez C. Mack Sewell

New York F. Bruce Coles F. Bruce Coles Perry F. Smith

New York City Susan Blank Steve Rubin Marcelle Layton

North Carolina Evelyn M. Foust Evelyn M. Foust Jeffrey Engel

North Dakota Kimberly Weis Kimberly Weis Kirby Kruger

Ohio Barbara Bradley Timothy Bahns Forrest W. Smith

Oklahoma Michael Harmon Chang Lee Brett Cauthen

Oregon Vada Latin Doug Harger Melvin Kohn

Pennsylvania Weston Ruhrig Steve Kowalewski Veronica Urdaneta

Philadelphia Caroline Johnson Martin Goldberg Veronica Urdaneta

Rhode Island Utpala Bandy Michael Gosciminski Utpala Bandy

South Carolina Lynda Kettinger Robert Ray James J. Gibson

South Dakota Laurie Gill David Morgan Lon Kightlinger

Tennessee Jeanece Seals Robert Burke Allen Craig

Texas Felipe Rocha Jim Lee Vincent Fonseca

Utah Teresa Garrett Tim Lane Robert T. Rolfs

Vermont Daniel Daltry Daniel Daltry Cortland Lohff

Virginia Casey Riley Casey Riley Carl Armstrong

Washington Larry Klopfenstein Larry Klopfenstein Jo Hofmann

West Virginia Loretta E. Haddy Margaret Taylor Loretta E. Haddy

Wisconsin Akan Ukoeninn Anthony Wade Jeffrey Davis

Wyoming Sharon Renter Sharon Renter Tracy Murphy

American Samoa Utoofili Asofaafeta Maga Sarona Maae Joseph Roth

Federated States of

Micronesia Nena S. Nena Louisa Helgenberger Nena S. Nena

Government of the

Marshall Islands Joseph Villagomz Ed Diaz James Hosfschneider

Guam Josie O'Mallan Bernadette Schumann Robert L. Haddock

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia Enid Garcia

Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez

Virgin Islands Darlene Carty Taetia Phillips-Dorsett Darlene Carty

160 Contributors Appendix STD Surveillance 2005